Provider Demographics
NPI:1306881958
Name:AL-KHATIB, AHMED M (MD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:M
Last Name:AL-KHATIB
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 1:202 WILDERNESS RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-2068
Mailing Address - Country:US
Mailing Address - Phone:270-651-9241
Mailing Address - Fax:
Practice Address - Street 1:1301 N RACE ST
Practice Address - Street 2:T J SAMSON COMMUNITY HOSPITAL
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3454
Practice Address - Country:US
Practice Address - Phone:270-651-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21904174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC63734Medicare UPIN