Provider Demographics
NPI:1306800164
Name:KHALED, IMAD H (MD)
Entity type:Individual
Prefix:DR
First Name:IMAD
Middle Name:H
Last Name:KHALED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10293 N 92ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4565
Mailing Address - Country:US
Mailing Address - Phone:480-747-6535
Mailing Address - Fax:480-747-6538
Practice Address - Street 1:10293 N 92ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4565
Practice Address - Country:US
Practice Address - Phone:480-747-6535
Practice Address - Fax:480-747-6538
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ27334207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ462515Medicaid
G43210Medicare UPIN
AZ462515Medicaid
Z69810Medicare PIN