Provider Demographics
NPI:1083664254
Name:ABUL-KHOUDOUD, OMRAN RIAD (MD, FACS, RVT)
Entity Type:Individual
Prefix:DR
First Name:OMRAN
Middle Name:RIAD
Last Name:ABUL-KHOUDOUD
Suffix:
Gender:M
Credentials:MD, FACS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-326-1675
Mailing Address - Fax:606-326-1436
Practice Address - Street 1:613 23RD ST STE 520
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2878
Practice Address - Country:US
Practice Address - Phone:606-326-1675
Practice Address - Fax:606-326-1436
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0936172086S0129X
KY400072086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64062821Medicaid
KY000000777096OtherANTHEM BCBS
OH2645436Medicaid
KY7499265OtherAETNA
WV3810006163Medicaid
OHH145790Medicare PIN
WV3810006163Medicaid
OH2645436Medicaid
KY000000777096OtherANTHEM BCBS
OHP01094307Medicare PIN
WV3810006163Medicaid
612927800OtherFEDERAL BLACK LUNG PGM
KY64062821Medicaid