Provider Demographics
NPI:1669640165
Name:KHALLAFI, HICHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HICHAM
Middle Name:
Last Name:KHALLAFI
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 1:3600 KOLBE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1677
Mailing Address - Country:US
Mailing Address - Phone:440-960-4416
Mailing Address - Fax:440-960-4417
Practice Address - Street 1:3600 KOLBE RD STE 205
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1677
Practice Address - Country:US
Practice Address - Phone:440-960-4416
Practice Address - Fax:440-960-4417
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35123425207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology