Provider Demographics
NPI:1568625168
Name:KHALIL, ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:KHALIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:GRANMAYEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 2.132
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-7626
Mailing Address - Fax:713-500-7639
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:MSB 2.132
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-7626
Practice Address - Fax:713-500-7639
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM94032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BX820OtherBCBSTX
TX195147703Medicaid
TX8AS172OtherBCBS
TX8AS172OtherBCBS
TX8L9944Medicare PIN