Provider Demographics
NPI:1477741122
Name:KHALIFE, WISSAM IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:WISSAM
Middle Name:IBRAHIM
Last Name:KHALIFE
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 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:409-772-4982
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:ROUTE 0553
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0553
Practice Address - Country:US
Practice Address - Phone:409-772-1533
Practice Address - Fax:409-772-4982
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4236207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease