Provider Demographics
NPI:1144209024
Name:SALLOUM, EMILE CHAWKI (MD)
Entity Type:Individual
Prefix:
First Name:EMILE
Middle Name:CHAWKI
Last Name:SALLOUM
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 81346
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78468-1346
Mailing Address - Country:US
Mailing Address - Phone:361-887-0067
Mailing Address - Fax:361-883-1484
Practice Address - Street 1:1625 RODD FIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4926
Practice Address - Country:US
Practice Address - Phone:361-887-0067
Practice Address - Fax:361-883-1484
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3846207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029575002Medicaid
TX5070549OtherAETNA
TX8846B0OtherBLUE CROSS BLUE SHIELD
TX8846B0Medicare PIN
TX8846B0OtherBLUE CROSS BLUE SHIELD
TX830005703Medicare PIN