Healthcare Provider Details

I. General information

NPI: 1578547360
Provider Name (Legal Business Name): KHALED A YASSINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR SUITE 800
TOLEDO OH
43606-3856
US

IV. Provider business mailing address

2109 HUGHES DR SUITE 800
TOLEDO OH
43606-3856
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3900
  • Fax:
Mailing address:
  • Phone: 419-291-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number35079813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: