Provider Demographics
NPI:1023110277
Name:KHALIL, RAFIK (MD)
Entity type:Individual
Prefix:
First Name:RAFIK
Middle Name:
Last Name:KHALIL
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:PO BOX 931286
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-1494
Mailing Address - Country:US
Mailing Address - Phone:888-719-9012
Mailing Address - Fax:
Practice Address - Street 1:225 ELYRIA ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1031
Practice Address - Country:US
Practice Address - Phone:330-948-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0619512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH738798OtherBUCKEYE COMMUNITY HEALTH PLAN
OH0141957Medicaid
OH58042OtherQUALCHOICE
OH000000025735OtherANTHEM BC/BS
OH026909600OtherBLACKLUNG
OH300076005OtherRRMC
OH026909600OtherBLACKLUNG
OH58042OtherQUALCHOICE