Healthcare Provider Details

I. General information

NPI: 1952832131
Provider Name (Legal Business Name): KHALIL ODEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date: 11/24/2025
Reactivation Date: 02/12/2026

III. Provider practice location address

1345 N JEFFERSON ST STE 321
MILWAUKEE WI
53202-2644
US

IV. Provider business mailing address

1345 N JEFFERSON ST STE 321
MILWAUKEE WI
53202-2644
US

V. Phone/Fax

Practice location:
  • Phone: 414-396-0896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number71227-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number71227-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: