Provider Demographics
NPI:1124041926
Name:KHALIL, AL-AMIN A (MD)
Entity Type:Individual
Prefix:
First Name:AL-AMIN
Middle Name:A
Last Name:KHALIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068757207L00000X, 207LP2900X
OH35068757K208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221103OtherUNISON
OH0583328OtherBCMH
OH363697OtherWELLCARE MEDICAID
OH000000516042OtherANTHEM
OH741624OtherBUCKEYE MEDICAID
MI1124041926Medicaid
OH000000503705OtherANTHEM
OH0208331Medicaid
OH5271596OtherAETNA
OHP00358800OtherMEDICARE RAILROAD
OH000000503705OtherANTHEM
OH0583328OtherBCMH
OH0208331Medicaid