Provider Demographics
NPI:1639180425
Name:RABADI, KHALED M (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:M
Last Name:RABADI
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 1:1451 44TH AVE S
Mailing Address - Street 2:SUITE 112D
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3434
Mailing Address - Country:US
Mailing Address - Phone:701-775-5800
Mailing Address - Fax:701-775-5200
Practice Address - Street 1:1451 44TH AVE S
Practice Address - Street 2:SUITE 112D
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3434
Practice Address - Country:US
Practice Address - Phone:701-775-5800
Practice Address - Fax:701-775-5200
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND710880821207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11889Medicaid
MN475717300Medicaid
ND21920Medicare ID - Type Unspecified
MN475717300Medicaid