Provider Demographics
NPI:1467517920
Name:KHALIFA, MAHMOUD ABDEL-FATTAH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:ABDEL-FATTAH
Last Name:KHALIFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22 MARTINO
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0957
Mailing Address - Country:US
Mailing Address - Phone:416-575-2858
Mailing Address - Fax:416-480-4271
Practice Address - Street 1:UNITY HEALTH CENTER
Practice Address - Street 2:1102 WEST MACARTHUR
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804
Practice Address - Country:US
Practice Address - Phone:405-273-2270
Practice Address - Fax:405-878-8171
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK17675207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH87089Medicare UPIN
OK249320901Medicare ID - Type Unspecified