Provider Demographics
NPI:1003857459
Name:KHALIL, SHOAIB (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOAIB
Middle Name:
Last Name:KHALIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-5214
Mailing Address - Country:US
Mailing Address - Phone:817-645-2322
Mailing Address - Fax:817-645-2360
Practice Address - Street 1:1900 E HENDERSON ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76031-5214
Practice Address - Country:US
Practice Address - Phone:817-645-2322
Practice Address - Fax:817-645-2360
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1710207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I43077Medicare UPIN
I43077Medicare UPIN
TX201760001Medicaid
TX8L7698Medicare PIN