Provider Demographics
NPI:1881274603
Name:ALIM, KHAIRIE (OCPRS)
Entity type:Individual
Prefix:
First Name:KHAIRIE
Middle Name:
Last Name:ALIM
Suffix:
Gender:M
Credentials:OCPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 E 208TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1801
Mailing Address - Country:US
Mailing Address - Phone:216-762-2808
Mailing Address - Fax:
Practice Address - Street 1:25201 CHAGRIN BLVD STE 390
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-5637
Practice Address - Country:US
Practice Address - Phone:216-910-9015
Practice Address - Fax:216-910-9015
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0002366175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty