Provider Demographics
NPI:1700868940
Name:MAHOOZI, LAILY (MD)
Entity Type:Individual
Prefix:
First Name:LAILY
Middle Name:
Last Name:MAHOOZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:C/O ILANKA COMMUNITY HEALTH CENTER
Mailing Address - Street 2:PO BOX 2290
Mailing Address - City:CORDOVA
Mailing Address - State:AK
Mailing Address - Zip Code:99574-2290
Mailing Address - Country:US
Mailing Address - Phone:907-424-3622
Mailing Address - Fax:907-424-3275
Practice Address - Street 1:705 SECOND ST
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574-2290
Practice Address - Country:US
Practice Address - Phone:907-424-3622
Practice Address - Fax:907-424-3275
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY002468207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism