Provider Demographics
NPI:1942562293
Name:EL KHATIB, AHMAD
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:EL KHATIB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 W GRANITE VALLEY DR STE E23
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-5798
Mailing Address - Country:US
Mailing Address - Phone:623-975-0500
Mailing Address - Fax:623-975-0705
Practice Address - Street 1:14300 W GRANITE VALLEY DR STE E23
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5798
Practice Address - Country:US
Practice Address - Phone:623-975-0500
Practice Address - Fax:623-975-0705
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ72430207RC0200X, 207R00000X, 207RS0012X, 207RP1001X
SD11336207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine