Provider Demographics
NPI:1467415158
Name:ALKUL, MOHAMAD JAMIL (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:JAMIL
Last Name:ALKUL
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 1:3420 22ND PLACE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3802 21ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1011
Practice Address - Country:US
Practice Address - Phone:806-725-4630
Practice Address - Fax:806-723-7809
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6847208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138182412Medicaid
TX8602M5Medicare ID - Type Unspecified
TX138182412Medicaid