Provider Demographics
NPI:1669486007
Name:KHALEEL, GHULAM MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:GHULAM
Middle Name:MOHAMMED
Last Name:KHALEEL
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 1:105 FRANKIE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2685
Mailing Address - Country:US
Mailing Address - Phone:870-247-6160
Mailing Address - Fax:870-247-6167
Practice Address - Street 1:105 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71605-3027
Practice Address - Country:US
Practice Address - Phone:870-247-6160
Practice Address - Fax:870-247-6167
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE44562084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N367OtherBLUE CROSS
ARP00272483Medicare PIN
ARH76336Medicare UPIN
AR5N367Medicare PIN