Provider Demographics
NPI:1306844980
Name:KHATAMI, SAYED S (MD)
Entity Type:Individual
Prefix:DR
First Name:SAYED
Middle Name:S
Last Name:KHATAMI
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 1:8877 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6211
Mailing Address - Country:US
Mailing Address - Phone:440-205-1225
Mailing Address - Fax:440-205-1275
Practice Address - Street 1:8877 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6211
Practice Address - Country:US
Practice Address - Phone:440-205-1225
Practice Address - Fax:440-205-1275
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082799207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500190Medicaid
OHP00695280OtherRR MEDICARE
9370811OtherMEDICARE GROUP
OH2803854OtherMEDICAID GROUP
9370811OtherMEDICARE GROUP
OH2803854OtherMEDICAID GROUP