Provider Demographics
NPI:1558344291
Name:IMSAIS, KHALIL YOUSEF (MD)
Entity Type:Individual
Prefix:
First Name:KHALIL
Middle Name:YOUSEF
Last Name:IMSAIS
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 1:212 CANE BAYOU LN
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-6627
Mailing Address - Country:US
Mailing Address - Phone:504-443-3589
Mailing Address - Fax:
Practice Address - Street 1:1020 SAINT ANDREW ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5022
Practice Address - Country:US
Practice Address - Phone:504-529-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD04199R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1180823Medicaid
5K036Medicare PIN
B60695Medicare UPIN