Provider Demographics
NPI:1407818503
Name:KHALILI, NIDAL ALI (MD)
Entity Type:Individual
Prefix:
First Name:NIDAL
Middle Name:ALI
Last Name:KHALILI
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 1:7551 TIMBERLAKE WAY
Mailing Address - Street 2:STE 240
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5422
Mailing Address - Country:US
Mailing Address - Phone:916-681-9401
Mailing Address - Fax:916-681-9417
Practice Address - Street 1:7551 TIMBERLAKE WAY
Practice Address - Street 2:STE 240
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5422
Practice Address - Country:US
Practice Address - Phone:916-681-9401
Practice Address - Fax:916-681-9417
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA881752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A881750Medicare ID - Type Unspecified
I18851Medicare UPIN