Provider Demographics
NPI:1780688382
Name:KARKOUTLY, AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:KARKOUTLY
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 3190
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-3190
Mailing Address - Country:US
Mailing Address - Phone:956-544-0755
Mailing Address - Fax:956-544-6657
Practice Address - Street 1:2300 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8714
Practice Address - Country:US
Practice Address - Phone:956-544-0755
Practice Address - Fax:956-544-6657
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4466207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX048530205Medicaid
TXG60704Medicare UPIN
TX048530205Medicaid
TX8F2577Medicare PIN
TXG60704Medicare UPIN