Provider Demographics
NPI:1588617633
Name:ABUL-KHOUDOUD, NAWAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:NAWAL
Middle Name:R
Last Name:ABUL-KHOUDOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-681-4747
Mailing Address - Fax:218-671-2595
Practice Address - Street 1:1720 HIGHWAY 59 S
Practice Address - Street 2:
Practice Address - City:THIEF RIVER FALLS
Practice Address - State:MN
Practice Address - Zip Code:56701-4331
Practice Address - Country:US
Practice Address - Phone:218-681-4747
Practice Address - Fax:218-671-2595
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN45503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN371J5ABOtherMNBS #
MN1833317OtherAMERICA'S PPO/ARAZ #
MN12967Medicaid
MN136998OtherUCARE #
MN0405695OtherMEDICA #
MNDA9021034672OtherPREFERRED ONE #
MNHP38709OtherHEALTHPARTNERS #
MN23354OtherNDBS #
MN0405695OtherMEDICA #
MN136998OtherUCARE #