Provider Demographics
NPI:1356403695
Name:KHALIL, JOSEF (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEF
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 1:1002 E. MCDOWELL RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2624
Mailing Address - Country:US
Mailing Address - Phone:602-388-4299
Mailing Address - Fax:602-388-4097
Practice Address - Street 1:1002 E. MCDOWELL RD.
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2624
Practice Address - Country:US
Practice Address - Phone:602-388-4299
Practice Address - Fax:602-388-4097
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ152762Medicaid
AZ165583Medicare UPIN
AZ152762Medicaid