MEDICARE: NADIM B KHATIB 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	26804	AZ

General Provider Information

NPI Number	:	1578526562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIM B KHATIB M.D.

Provider Business Mailing Address
First Line	:	PO BOX 20758
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86439-0758
Country	:	US
Telephone Number	:	928-763-9009
Fax Number	:	928-763-9292

Provider Business Practice Location Address
First Line	:	2755 SILVER CREEK RD
Second Line	:	SUITE 109
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7904
Country	:	US
Telephone Number	:	928-763-9009
Fax Number	:	928-763-9292

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	12/18/2007

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