Provider Demographics
NPI:1922175694
Name:KOLEILAT, MAJED A (MD)
Entity Type:Individual
Prefix:
First Name:MAJED
Middle Name:A
Last Name:KOLEILAT
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 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9459
Mailing Address - Fax:812-858-4546
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9459
Practice Address - Fax:812-858-4546
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061301A207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000381373OtherANTHEM
IN200538870Medicaid
IN000000381373OtherANTHEM
IN849820QQQMedicare PIN
IN257900KKMedicare PIN
IN200538870Medicaid