Individual
MTANIOUS MAKHOUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
247 S BURNETT RD, SPRINGFIELD, OH 45505-2639
(937) 505-9501
(937) 521-1090
Mailing address
247 S BURNETT RD, SPRINGFIELD, OH 45505-2639
(937) 505-9501
(937) 521-1090
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.091274
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2935748
—
OH
Enumeration date
04/02/2008
Last updated
07/29/2015
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