=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952540593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHOENIX FAMILY MEDICAL CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2009
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1002 E MCDOWELL RD STE A
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85006-2624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-388-4299
-----------------------------------------------------
Fax | 602-388-4097
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1002 E MCDOWELL RD STE A
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85006-2624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-388-4299
-----------------------------------------------------
Fax | 602-388-4097
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | DR. JOSEF KHALIL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 602-388-4299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 36157
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------