Provider Demographics
NPI:1528775160
Name:MAHMOUD, ALKHATEM MOHAMED SR
Entity type:Individual
Prefix:MR
First Name:ALKHATEM
Middle Name:MOHAMED
Last Name:MAHMOUD
Suffix:SR
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 1:282 PLEASANT MEADOW BOULEVARD APT 13
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44224
Mailing Address - Country:US
Mailing Address - Phone:206-658-7179
Mailing Address - Fax:
Practice Address - Street 1:282 PLEASANT MEADOW BOULEVARD APT 13
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44224
Practice Address - Country:US
Practice Address - Phone:206-658-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHVN026258172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVN026258OtherDRIVER LICENSE