Provider Demographics
NPI:1184838369
Name:KHADAM-MAKHOUL, HANAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HANAN
Middle Name:
Last Name:KHADAM-MAKHOUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 BAPTIST HEALTH DR
Mailing Address - Street 2:STE. 560
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6321
Mailing Address - Country:US
Mailing Address - Phone:501-225-6602
Mailing Address - Fax:501-225-6642
Practice Address - Street 1:9601 BAPTIST HEALTH DR
Practice Address - Street 2:STE. 560
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-225-6602
Practice Address - Fax:501-225-6642
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3597207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165681001Medicaid