Provider Demographics
NPI:1396837795
Name:KAMAL, KAMALELDIN HASSAN (MD)
Entity Type:Individual
Prefix:
First Name:KAMALELDIN
Middle Name:HASSAN
Last Name:KAMAL
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 1:753 CLASSON AVE
Mailing Address - Street 2:#5L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4647
Mailing Address - Country:US
Mailing Address - Phone:646-403-1976
Mailing Address - Fax:347-365-1901
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-4555
Practice Address - Fax:228-523-4515
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239518207R00000X, 208M00000X
IN01057156A208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000754235OtherANTHEM PROVIDER NUMBER
IN200899750Medicaid
INM400066411Medicare PIN
INP01078469Medicare PIN