Provider Demographics
NPI:1336124429
Name:ALKHERSAM, HUSAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSAM
Middle Name:H
Last Name:ALKHERSAM
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 1:1604 HOSPITAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6930
Mailing Address - Country:US
Mailing Address - Phone:817-848-4485
Mailing Address - Fax:817-848-4490
Practice Address - Street 1:1604 HOSPITAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6930
Practice Address - Country:US
Practice Address - Phone:817-848-4485
Practice Address - Fax:817-848-4490
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL42142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160242702Medicaid
TXG15735Medicare UPIN
TX160242702Medicaid