Provider Demographics
NPI:1962404517
Name:ALKHATEEB, MOHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:ALKHATEEB
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 1:2750 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1100
Mailing Address - Country:US
Mailing Address - Phone:989-635-4023
Mailing Address - Fax:989-635-5297
Practice Address - Street 1:2750 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1100
Practice Address - Country:US
Practice Address - Phone:989-635-4023
Practice Address - Fax:989-635-5297
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074589207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4455715Medicaid
OH060069949OtherRAILROAD MEDICARE
OH2360823Medicaid
MIM8570007Medicare PIN
OH060069949OtherRAILROAD MEDICARE
F72279Medicare UPIN