Provider Demographics
NPI:1023704715
Name:DWEIK, KHALED ISSAM MOHAMMEDNAEEM (MD)
Entity type:Individual
Prefix:DR
First Name:KHALED
Middle Name:ISSAM MOHAMMEDNAEEM
Last Name:DWEIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13400 E. SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259
Mailing Address - Country:US
Mailing Address - Phone:480-342-4847
Mailing Address - Fax:507-538-8232
Practice Address - Street 1:13400 E. SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259
Practice Address - Country:US
Practice Address - Phone:480-342-4847
Practice Address - Fax:507-538-8232
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR80057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine