Provider Demographics
NPI:1700867959
Name:KHALIL, AMIN YOUSSEF (MD)
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:YOUSSEF
Last Name:KHALIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:A
Other - Last Name:KHALIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:855 W MAPLE ST
Mailing Address - Street 2:HARTVILLE
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9668
Mailing Address - Country:US
Mailing Address - Phone:330-877-9388
Mailing Address - Fax:330-488-2907
Practice Address - Street 1:855 W MAPLE ST
Practice Address - Street 2:HARTVILLE
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9668
Practice Address - Country:US
Practice Address - Phone:330-877-9388
Practice Address - Fax:330-488-2907
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077196207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22639OtherQUALCHOICE
OH101425OtherBLACK LUNG
OH341960347OtherAETNA
OH341960347AOtherAULTCARE
OH174396OtherHIGHMARK BC/BS
OH1962238OtherFIRST HEALTH NETWORK
OH340960347OtherSUMMA
OH000000213674OtherANTHEM
OH104450OtherKAISER PERMANENTE
OH341960347027Medicaid
OH2187271Medicaid
OH341960347OtherCIGNA
OHP00365055Medicare PIN
OH104450OtherKAISER PERMANENTE
OHH07638Medicare UPIN
OH2187271Medicaid