Basic Information
Provider Information
NPI: 1184889180
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABUHANTTASH
FirstName: KHALED
MiddleName: M N
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 2142 N COVE BLVD
Address2: TOLEDO HOSPITAL
City: TOLEDO
State: OH
PostalCode: 436063895
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3045 ARLINGTON AVE
Address2: GRADUATE MEDICAL EDUCATION- MS1050
City: TOLEDO
State: OH
PostalCode: 436142570
CountryCode: US
TelephoneNumber: 4193834244
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/19/2008
LastUpdateDate: 06/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
208M00000X25755NEN Allopathic & Osteopathic PhysiciansHospitalist 
208M00000X35.122846OHY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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