Provider Demographics
NPI:1003102427
Name:KHALEEL, ZIYAD LUCKMAN (MB CHB)
Entity Type:Individual
Prefix:DR
First Name:ZIYAD
Middle Name:LUCKMAN
Last Name:KHALEEL
Suffix:
Gender:M
Credentials:MB CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7693 MOUNTAIN ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5421
Mailing Address - Country:US
Mailing Address - Phone:801-971-1893
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY HOSPITAL
Practice Address - Street 2:30 NORTH 1900 EAST
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2140
Practice Address - Country:US
Practice Address - Phone:801-581-4624
Practice Address - Fax:801-585-7330
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program