Provider Demographics
NPI:1922090273
Name:HADELI, KHALED O (MD)
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:O
Last Name:HADELI
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 1:9420 E GOLF LINKS ROAD, STE 108
Mailing Address - Street 2:PMB 284
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730
Mailing Address - Country:US
Mailing Address - Phone:520-447-7413
Mailing Address - Fax:520-210-7422
Practice Address - Street 1:9420 E GOLF LINKS ROAD, STE 108
Practice Address - Street 2:PMB 284
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730
Practice Address - Country:US
Practice Address - Phone:520-447-7413
Practice Address - Fax:520-210-7422
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26115207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ512336Medicaid
AZZ70831Medicare PIN
AZ512336Medicaid