Provider Demographics
NPI:1710967203
Name:KHALAF, TAGREED M (MD)
Entity Type:Individual
Prefix:
First Name:TAGREED
Middle Name:M
Last Name:KHALAF
Suffix:
Gender:F
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:CENTER FOR SPINE HEALTH
Mailing Address - Street 2:9500 EUCLID AVENUE/ C21
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-7378
Mailing Address - Fax:216-445-9679
Practice Address - Street 1:CENTER FOR SPINE HEALTH
Practice Address - Street 2:9500 EUCLID AVENUE/ C21
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-7378
Practice Address - Fax:216-445-9679
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-090862208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2785964Medicaid
OH7379361Medicare PIN
I37245Medicare UPIN