Provider Demographics
NPI:1992791263
Name:KHALAFI, KAMAL (MD)
Entity type:Individual
Prefix:
First Name:KAMAL
Middle Name:
Last Name:KHALAFI
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:PO BOX 391405
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-8405
Mailing Address - Country:US
Mailing Address - Phone:216-491-7660
Mailing Address - Fax:216-491-7662
Practice Address - Street 1:4200 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 430
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7051
Practice Address - Country:US
Practice Address - Phone:216-491-7660
Practice Address - Fax:216-491-7662
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074605K207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2183515Medicaid
1992791263OtherNPI
OH4020067Medicare PIN
OH2183515Medicaid