Provider Demographics
NPI:1528368479
Name:HUSSAMADDIN AL-KHADOUR MD PA
Entity Type:Organization
Organization Name:HUSSAMADDIN AL-KHADOUR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSSAMADDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHADOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-364-8787
Mailing Address - Street 1:616 CYPRESS CREEK PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3025
Mailing Address - Country:US
Mailing Address - Phone:281-364-8787
Mailing Address - Fax:713-636-9088
Practice Address - Street 1:616 CYPRESS CREEK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3025
Practice Address - Country:US
Practice Address - Phone:281-364-8787
Practice Address - Fax:713-636-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1257207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty