Provider Demographics
NPI:1518318096
Name:KADOUS, ADEL (MD)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:
Last Name:KADOUS
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 1:2450 S TELSHOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5069
Mailing Address - Country:US
Mailing Address - Phone:575-521-5385
Mailing Address - Fax:
Practice Address - Street 1:600 ANTHONY DR
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9381
Practice Address - Country:US
Practice Address - Phone:575-882-2128
Practice Address - Fax:575-882-3837
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRS2016-0469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine