MEDICARE: KHALIL INNABI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	204019	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336184290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHALIL INNABI M.D.

Provider Business Mailing Address
First Line	:	45 LUDLOW ST
Second Line	:	SUITE 700
City	:	YONKERS
State	:	NY
Zip	:	10705-1947
Country	:	US
Telephone Number	:	914-375-2700
Fax Number	:	914-375-0404

Provider Business Practice Location Address
First Line	:	45 LUDLOW ST
Second Line	:	SUITE 700
City	:	YONKERS
State	:	NY
Zip	:	10705-1947
Country	:	US
Telephone Number	:	914-375-2700
Fax Number	:	914-375-0404

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	09/27/2012

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