Provider Demographics
NPI:1487740296
Name:ALKHATIB, AMER AHMAD (MD)
Entity type:Individual
Prefix:
First Name:AMER
Middle Name:AHMAD
Last Name:ALKHATIB
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 1:10109 E 79TH ST
Mailing Address - Street 2:CANCER TREATMENT CENTERS OF AMERICA
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4564
Mailing Address - Country:US
Mailing Address - Phone:918-286-5000
Mailing Address - Fax:
Practice Address - Street 1:10109 E 79TH ST
Practice Address - Street 2:CANCER TREATMENT CENTERS OF AMERICA
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4564
Practice Address - Country:US
Practice Address - Phone:918-286-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046051207R00000X
AZ44370207RG0100X
OK29020207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG000362000OtherMEDICARE GROUP
AZ615484Medicaid
WA8470312Medicaid
WAP00395875OtherRAILROAD MEDICARE
AZ615484Medicaid
AZZ148688Medicare PIN