Provider Demographics
NPI:1053774760
Name:HANAN KHADAM-MAKHOUL, M.D., P.A.
Entity type:Organization
Organization Name:HANAN KHADAM-MAKHOUL, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-225-6602
Mailing Address - Street 1:9601 BAPTIST HEALTH DR
Mailing Address - Street 2:560
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-225-6602
Mailing Address - Fax:
Practice Address - Street 1:9601 BAPTIST HEALTH DR
Practice Address - Street 2:560
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-225-6602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty