Provider Demographics
NPI:1205828225
Name:KHALIL, SHEREIF (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEREIF
Middle Name:
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 1:30390 STILLWATER LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1577
Mailing Address - Country:US
Mailing Address - Phone:440-248-9055
Mailing Address - Fax:
Practice Address - Street 1:30390 STILLWATER LN
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-1577
Practice Address - Country:US
Practice Address - Phone:440-248-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350610152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH915942Medicaid
OHKH0796087Medicare ID - Type Unspecified
OH915942Medicaid