Basic Information
| Provider Information | |||||||||
| NPI: | 1295200632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHALIL | ||||||||
| FirstName: | KAMRAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12518 S CEDAR AVE | ||||||||
| Address2: | |||||||||
| City: | JENKS | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740374983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188412848 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 384 S 33RD ST STE D | ||||||||
| Address2: | |||||||||
| City: | MUSKOGEE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744015065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186860400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2018 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2017030862 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.