Provider Demographics
NPI:1053387761
Name:DEEB, KHALEEL (MD)
Entity type:Individual
Prefix:
First Name:KHALEEL
Middle Name:
Last Name:DEEB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 LEE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5122
Mailing Address - Country:US
Mailing Address - Phone:216-417-6166
Mailing Address - Fax:216-417-8676
Practice Address - Street 1:7575 NORTHCLIFF AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3267
Practice Address - Country:US
Practice Address - Phone:216-749-8265
Practice Address - Fax:216-749-8222
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060323D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0880186Medicaid
10790454OtherCAQH
341783789036OtherCARE SOURCE
OHD368301OtherDIAGNOSTIC GROUP MEDICARE
OH3610861OtherASC MEDICARE GROUP
OH080097144OtherRAILROAD MEDICARE
34-1783OtherGROUP TIN
1780634279OtherGROUP NPI
OH4255074OtherAETNA
OH9273172OtherMEDICARE GROUP
CA4511OtherRR MEDICARE GROUP
102976OtherKAISER
OH10790454OtherCAQH
000000031846OtherANTHEM
OH102976OtherKAISER
F60323OtherSUMMACARE APEX
102976OtherKAISER
OH3610861OtherASC MEDICARE GROUP