Khaled Al-Taieb, M.D.
Individual provider Active NPI Internal Medicine Physician · Youngstown, OH
NPI 1003144643 · NPPES record last updated Nov 19, 2009
Key facts
- NPI
- 1003144643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 4301094021 (MI)
- Practice address
- 465 Gypsy LN Apt 407
Youngstown, OH 44504-1364 - Phone
- (330) 391-0462
- NPI assigned
- Nov 19, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Henry Ford Health System
Practice addresses (Care Compare)
1 Ford PL
Detroit, MI 48202-3450
Phone (313) 874-6677
2799 W Grand Blvd
Detroit, MI 48202-2608
5500 Auto Club Dr
Dearborn, MI 48126-2779
Phone (313) 425-4500
Hospital & facility affiliations
- Henry Ford Home Health Care
- Henry Ford Health Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100118000056 | MI | Practitioner - Internal Medicine | 2567504319 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henry Ford Health System | Current | Accepting new patients | |
| Henry Ford Health System | Internal Medicine | Current |
Accepting new patients |
| Henry Ford Health System | Current |
Accepting new patients | |
| Henry Ford Maplegrove Center | Past | Accepting new patients |
Locations
1961 S Telegraph Rd
Bloomfield Township, MI 48302
Phone (248) 319-6190
1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953
2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062
22505 Allen Rd
Woodhaven, MI 48183
Phone (734) 671-6217
Interoperability endpoints
- kaltaieb37102@direct.hfhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 4301094021 | MI | Yes |
Addresses
Primary practice location
465 Gypsy LN Apt 407
Youngstown, OH 44504-1364
Mailing address
465 Gypsy LN Apt 407
Youngstown, OH 44504-1364
Phone (330) 391-0462
Other providers in Youngstown, OH
- Lisa E Airwyke
- Tara Akins
- Al Service LLC
- Alwatheq Al-Itelat
- Pamela Al-Refaei
- Johnny Alayon
- Suhad Albaat
- Amber Albaugh
- Antony George Albert
- Andre Renato Albuquerque Morais
All providers in Youngstown, OH · Internal Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.