Provider Demographics
NPI:1619951290
Name:KHALIL, ARIF (MD)
Entity Type:Individual
Prefix:
First Name:ARIF
Middle Name:
Last Name:KHALIL
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 1:4320 FIR ST UNIT 320
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3076
Mailing Address - Country:US
Mailing Address - Phone:219-392-7992
Mailing Address - Fax:219-392-7987
Practice Address - Street 1:4320 FIR ST UNIT 320
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-3076
Practice Address - Country:US
Practice Address - Phone:219-392-7992
Practice Address - Fax:219-392-7987
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-100068207RI0011X, 207RC0000X
IN0100384A207RI0011X
IN01050384A207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200254360AMedicaid
IN200254360Medicaid
P00679601OtherRAILROAD MEDICARE
IN000000095323OtherANTHEM PIN
IN200254360AMedicaid
IN707880HMedicare PIN
IN000000095323OtherANTHEM PIN
IN200254360Medicaid