Provider Demographics
NPI:1841240421
Name:KULAYLAT, NUHAD AFIF (MD)
Entity Type:Individual
Prefix:DR
First Name:NUHAD
Middle Name:AFIF
Last Name:KULAYLAT
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 1:1349 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-1727
Mailing Address - Country:US
Mailing Address - Phone:573-334-9564
Mailing Address - Fax:573-334-1879
Practice Address - Street 1:1012 SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-1913
Practice Address - Country:US
Practice Address - Phone:573-334-9564
Practice Address - Fax:573-334-1879
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3226207RN0300X
IL036-107478207RN0300X
MO2002006960207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO481120OtherHEALTHLINK
AR5M291OtherBLUE CROSS BLUE SHIELD
110237678OtherRAIL ROAD MEDICARE
096560OtherHEALTH ALLIANCE
MO205990708Medicaid
MO158646OtherBLUE CROSS BLUE SHIELD
MO205990716Medicaid
AR148096001Medicaid
2104551OtherCOVENTRY HEALTHCARE