Provider Demographics
NPI:1588676811
Name:ADILI-KHAMS, BABEK (MD)
Entity Type:Individual
Prefix:
First Name:BABEK
Middle Name:
Last Name:ADILI-KHAMS
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 5183
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5183
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:29101 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352-9706
Practice Address - Country:US
Practice Address - Phone:909-336-9715
Practice Address - Fax:909-336-5751
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN502485400Medicaid
MS20250OtherMS LICENSE
MS20250OtherMS LICENSE
I34756Medicare UPIN