Provider Demographics
NPI:1518917103
Name:KHALIL, MAGDY W (MD)
Entity Type:Individual
Prefix:
First Name:MAGDY
Middle Name:W
Last Name:KHALIL
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-0189
Mailing Address - Country:US
Mailing Address - Phone:812-801-0156
Mailing Address - Fax:812-801-0276
Practice Address - Street 1:1373 E STATE ROAD 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0156
Practice Address - Fax:812-801-0276
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28716207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64287162Medicaid
KY000000044626OtherANTHEM
IN100320160AMedicaid
KY1051969Medicaid
KY050027489Medicare ID - Type UnspecifiedRAILROAD MEDICARE
KY1269280Medicare ID - Type UnspecifiedKENTUCKY MEDICARE
KYE03671Medicare UPIN
IN100320160AMedicaid
KY1051969Medicaid