Healthcare Provider Details

I. General information

NPI: 1265548341
Provider Name (Legal Business Name): FATEH ELKHATIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 S WESTERN AVE STE 3030
OKLAHOMA CITY OK
73109-3492
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 405-644-6232
  • Fax: 405-636-7468
Mailing address:
  • Phone: 405-644-6232
  • Fax: 405-636-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28367
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number28367
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: