Provider Demographics
NPI:1598290579
Name:AL KHAWLANI, TALAL SALEH (MBBS)
Entity Type:Individual
Prefix:
First Name:TALAL
Middle Name:SALEH
Last Name:AL KHAWLANI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2157 MAIN STREET
Mailing Address - Street 2:SISTERS HOSPTIAL 5TH FLOOR DEPARTMENT OF MEDICINE
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214
Mailing Address - Country:US
Mailing Address - Phone:716-862-1423
Mailing Address - Fax:716-862-1867
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214
Practice Address - Country:US
Practice Address - Phone:716-862-1423
Practice Address - Fax:716-862-1867
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2018-02-13
Deactivation Date:2017-11-29
Deactivation Code:
Reactivation Date:2018-02-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program