Provider Demographics
NPI:1053506592
Name:MAHMOUD SHEIKH-KHALIL MD APMC
Entity Type:Organization
Organization Name:MAHMOUD SHEIKH-KHALIL MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:SHEIKH
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-281-2008
Mailing Address - Street 1:PO BOX 4199
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71211-4199
Mailing Address - Country:US
Mailing Address - Phone:318-281-2008
Mailing Address - Fax:318-281-2038
Practice Address - Street 1:501 DURHAM ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5012
Practice Address - Country:US
Practice Address - Phone:318-281-2008
Practice Address - Fax:318-281-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12276R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1534978Medicaid
5A227Medicare PIN
G66569Medicare UPIN