Provider Demographics
NPI:1578526562
Name:KHATIB, NADIM B (MD)
Entity Type:Individual
Prefix:
First Name:NADIM
Middle Name:B
Last Name:KHATIB
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:PO BOX 20758
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86439-0758
Mailing Address - Country:US
Mailing Address - Phone:928-763-9009
Mailing Address - Fax:928-763-9292
Practice Address - Street 1:2755 SILVER CREEK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7904
Practice Address - Country:US
Practice Address - Phone:928-763-9009
Practice Address - Fax:928-763-9292
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG74455Medicare UPIN
AZ100306Medicare PIN