Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4301094021 | MI |
Y | 111NI0900X | Internist | 4301094021 | MI |
NPI | 1003144643 |
---|---|
Provider Name | Dr. Khaled Al-Taieb |
First Address | Youngstown, OH 44504-1364 |
Second Address | Youngstown, OH 44504-1364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2009 |
Last Update Date | 19/11/2009 |