Provider Demographics
NPI:1114904745
Name:MAKHOUL, JAMAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:
Last Name:MAKHOUL
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 1:4590 S LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1810
Mailing Address - Country:US
Mailing Address - Phone:314-849-7669
Mailing Address - Fax:314-849-7670
Practice Address - Street 1:6065 HELEN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134-2013
Practice Address - Country:US
Practice Address - Phone:314-522-6410
Practice Address - Fax:314-522-0281
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO109410207P00000X, 208M00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205292618Medicaid
MO5013298Medicare ID - Type UnspecifiedINSTITUTE
MO205292618Medicaid
MO206010753Medicare ID - Type UnspecifiedDOH