Provider Demographics
NPI:1801843024
Name:KHODEIR, MOHAMED S (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:S
Last Name:KHODEIR
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 1:1301 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2460
Mailing Address - Country:US
Mailing Address - Phone:614-299-6600
Mailing Address - Fax:614-421-3111
Practice Address - Street 1:1301 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2460
Practice Address - Country:US
Practice Address - Phone:614-299-6600
Practice Address - Fax:614-421-3111
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1460582084P0800X
KY360102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64023849Medicaid
KY1896301Medicare PIN