Healthcare Provider Details

I. General information

NPI: 1023866266
Provider Name (Legal Business Name): ANTONIOUS MEKHAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ALKYRE RUN STE 340
WESTERVILLE OH
43082-6911
US

IV. Provider business mailing address

450 ALKYRE RUN STE 340
WESTERVILLE OH
43082-6911
US

V. Phone/Fax

Practice location:
  • Phone: 614-647-2526
  • Fax:
Mailing address:
  • Phone: 614-647-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00036203
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: