Provider Demographics
NPI:1124183710
Name:ABDEL-KHALEK, IHAB ABDEL-AZIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:IHAB
Middle Name:ABDEL-AZIZ
Last Name:ABDEL-KHALEK
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:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27528-0510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11708 HWY 70 WEST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520
Practice Address - Country:US
Practice Address - Phone:919-550-2770
Practice Address - Fax:919-553-7926
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99041497208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12926OtherBLUE CROSS BLUE SHIELD
NC8912926Medicaid
NC8912926Medicaid