Healthcare Provider Details

I. General information

NPI: 1528408499
Provider Name (Legal Business Name): HAYTHAM ALKHAIMY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOSPITAL DR
LOGAN WV
25601
US

IV. Provider business mailing address

20 HOSPITAL DR
LOGAN WV
25601-3452
US

V. Phone/Fax

Practice location:
  • Phone: 304-831-1643
  • Fax:
Mailing address:
  • Phone: 304-831-1643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number27015
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number27015
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number006112
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27015
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: