Provider Demographics
NPI:1356640726
Name:KAHOOK, KHALID S (MD,)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:S
Last Name:KAHOOK
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 THEDA CLARK PLAZA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2790
Mailing Address - Country:US
Mailing Address - Phone:920-751-8666
Mailing Address - Fax:920-751-0288
Practice Address - Street 1:200 THEDA CLARK PLAZA
Practice Address - Street 2:SUITE 110
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2790
Practice Address - Country:US
Practice Address - Phone:920-751-8666
Practice Address - Fax:920-751-0288
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2017-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI6519320207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400293985OtherMEDICARE PTAN