Provider Demographics
NPI:1750372900
Name:ALKHATIB, HANI SHABAN (MB, BCH)
Entity type:Individual
Prefix:
First Name:HANI
Middle Name:SHABAN
Last Name:ALKHATIB
Suffix:
Gender:M
Credentials:MB, BCH
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Mailing Address - Street 1:1900 CENTRACARE CIR, #1600
Mailing Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA SPECIALTY/ONCOLOGY
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-229-4907
Mailing Address - Fax:320-229-5160
Practice Address - Street 1:1900 CENTRACARE CIR, #1600
Practice Address - Street 2:CENTRACARE CLINIC HEALTH PLAZA SPECIALTY/ONCOLOGY
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-229-4907
Practice Address - Fax:320-229-5160
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2010-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN34615207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
900000917OtherRR MEDICARE
1001406OtherPREFERRED ONE
499R1KHOtherBLUE CROSS BLUE SHIELD
009517600OtherMEDICAL ASSISTANCE
3600190OtherMEDICA HEALTH PLANS
MN009517600Medicaid
05T20ALOtherBLUE CROSS BLUE SHIELD
2129263OtherFIRST HEALTH PLAN
HP27008OtherHEALTH PARTNERS
830000282OtherMEDICARE
112085OtherU CARE
20111OtherARAZ GRP AMERICA'S PPO
3600190OtherMEDICA HEALTH PLANS
F14792Medicare UPIN