Provider Demographics
NPI:1851540108
Name:BEKDACHE, KHALDOUN KAMAL (MD)
Entity Type:Individual
Prefix:
First Name:KHALDOUN
Middle Name:KAMAL
Last Name:BEKDACHE
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 1:43 WHITING HILL RD
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-4949
Mailing Address - Fax:207-973-4466
Practice Address - Street 1:417 STATE ST. SURGERY AND TRAUMA SPECIALISTS OF MAINE
Practice Address - Street 2:WEBBER WEST, SUITE 340
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:209-973-4949
Practice Address - Fax:207-973-4466
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0540132086S0102X, 390200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program