Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 30763 | NY |
Y | 207RI0011X | Interventional Cardiology | 50635 | AZ |
NPI | 1083977599 |
---|---|
Provider Name | Dr. Basil Al Khatib |
First Address | Phoenix, AZ 85016-4352 |
Second Address | Phoenix, AZ 85016-4352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128731 | (05) | AZ |