Provider Demographics
NPI:1386600310
Name:KHATIB, ABD G (MD)
Entity type:Individual
Prefix:
First Name:ABD
Middle Name:G
Last Name:KHATIB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABD
Other - Middle Name:G
Other - Last Name:KHATIB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:659 W HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6925
Mailing Address - Country:US
Mailing Address - Phone:715-831-4444
Mailing Address - Fax:920-526-5248
Practice Address - Street 1:659 W HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6925
Practice Address - Country:US
Practice Address - Phone:715-831-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25187207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease