Basic Information
| Provider Information | |||||||||
| NPI: | 1467517920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHALIFA | ||||||||
| FirstName: | MAHMOUD | ||||||||
| MiddleName: | ABDEL-FATTAH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 MARTINO | ||||||||
| Address2: | |||||||||
| City: | LADERA RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926940957 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4165752858 | ||||||||
| FaxNumber: | 4164804271 | ||||||||
| Practice Location | |||||||||
| Address1: | UNITY HEALTH CENTER | ||||||||
| Address2: | 1102 WEST MACARTHUR | ||||||||
| City: | SHAWNEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052732270 | ||||||||
| FaxNumber: | 4058788171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 17675 | OK | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.