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General NPI Number Information
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NPI Number | 1164720363
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Entity Type | Organization
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Legal Business Name | MAHMOUD KHATTAB MD INC
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 9390 BIG HORN BLVD SUITE 145
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City | ELK GROVE
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State | CA
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Zip | 95758-7978
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Country | US
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Telephone | 916-691-6666
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Fax | 916-691-6668
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Provider Business Mailing Address
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Address Line | 9390 BIG HORN BLVD SUITE 145
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City | ELK GROVE
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State | CA
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Zip | 95758-7978
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Country | US
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Telephone | 916-691-6666
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Fax | 916-691-6668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAHMOUD KHATTAB
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Credential | MD
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Telephone | 916-691-6666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A97693
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License Number State | CA
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