Provider Demographics
NPI:1114186459
Name:AILABOUNI, LUAY D (MD)
Entity Type:Individual
Prefix:
First Name:LUAY
Middle Name:D
Last Name:AILABOUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8650
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:1100 GOETHALS DRIVE, 2ND FLOOR
Practice Address - Street 2:KADLEC CLINIC GENERAL & COLORECTAL SURGERY
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3304
Practice Address - Country:US
Practice Address - Phone:509-942-3185
Practice Address - Fax:509-946-1850
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD60323856208600000X
WAMD30623856208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0310710OtherL&I
OR500655571Medicaid
WA1114186459Medicaid
WAG8918815Medicare PIN