Provider Demographics
NPI:1790736528
Name:HENNES, HALIM MAHFOUZ A (MD)
Entity Type:Individual
Prefix:DR
First Name:HALIM MAHFOUZ
Middle Name:A
Last Name:HENNES
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 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-462-2100
Mailing Address - Fax:214-456-7736
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-462-2100
Practice Address - Fax:214-456-7736
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI263182080P0204X
TXN00902080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000120JOtherHUMANA
WI30751700Medicaid
0023973601Medicare ID - Type Unspecified
WI30751700Medicaid