Provider Demographics
NPI:1144868571
Name:KHALIFA, AHMAD (SA-C,MBBCH,MSC,MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:KHALIFA
Suffix:
Gender:M
Credentials:SA-C,MBBCH,MSC,MD
Other - Prefix:
Other - First Name:AHMAD
Other - Middle Name:OSAMA MOHAMED AHMAD
Other - Last Name:KHALIFA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SA-C,MBBCH,MSC,MD
Mailing Address - Street 1:2540 N MORELAND BLVD APT 211
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1357
Mailing Address - Country:US
Mailing Address - Phone:216-820-5908
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-820-5908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19-512246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant