Provider Demographics
NPI:1952540593
Name:PHOENIX FAMILY MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:PHOENIX FAMILY MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-388-4299
Mailing Address - Street 1:1002 E MCDOWELL RD STE A
Mailing Address - Street 2:
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 STE A
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ152762Medicaid
AZZ127579Medicare PIN
AZ165583Medicare UPIN