Provider Demographics
NPI:1801835897
Name:SHEIKH-KHALIL, MAHMOUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:SHEIKH-KHALIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAHMOUD
Other - Middle Name:
Other - Last Name:SHEIKH-KHALIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:501 DURHAM ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-5012
Mailing Address - Country:US
Mailing Address - Phone:318-281-2008
Mailing Address - Fax:318-281-2038
Practice Address - Street 1:501 DURHAM ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-5012
Practice Address - Country:US
Practice Address - Phone:318-281-2008
Practice Address - Fax:318-281-2038
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12276R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1534978Medicaid
LA1534978Medicaid
LA5A227BC20Medicare PIN