Provider Demographics
NPI:1518650811
Name:KHMOUS, FERAS MOHAMMED
Entity Type:Individual
Prefix:MR
First Name:FERAS
Middle Name:MOHAMMED
Last Name:KHMOUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2042 CAMARO AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1715
Mailing Address - Country:US
Mailing Address - Phone:614-696-4704
Mailing Address - Fax:
Practice Address - Street 1:2042 CAMARO AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1715
Practice Address - Country:US
Practice Address - Phone:614-396-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH254665342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company