Provider Demographics
NPI:1164494050
Name:EL HALABI, ISSAM MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:ISSAM
Middle Name:MOHAMMED
Last Name:EL HALABI
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 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-660-3632
Mailing Address - Fax:918-660-3631
Practice Address - Street 1:2815 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1013
Practice Address - Country:US
Practice Address - Phone:918-619-4300
Practice Address - Fax:918-619-4322
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK185122080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100177060CMedicaid
OK242412203Medicare ID - Type Unspecified
OK100177060CMedicaid