Provider Demographics
NPI:1407851736
Name:RAFFOUL, KHALIL A (MD)
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:A
Last Name:RAFFOUL
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 1:1000 REGENCY CT
Mailing Address - Street 2:STE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3074
Mailing Address - Country:US
Mailing Address - Phone:419-882-0588
Mailing Address - Fax:419-885-3070
Practice Address - Street 1:1000 REGENCY CT
Practice Address - Street 2:STE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3074
Practice Address - Country:US
Practice Address - Phone:419-882-0588
Practice Address - Fax:419-885-3070
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070799207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004651135OtherAETNA
02267OtherPARAMOUNT
1427801OtherUNITED HEALTHCARE
OH0297450Medicaid
000000127266OtherANTHEM
OH180027814OtherRAILROAD MEDICARE
OH180027814OtherRAILROAD MEDICARE
OH0814991Medicare PIN