Provider Demographics
NPI:1962473660
Name:KHALIL, MOHAMMAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:A
Last Name:KHALIL
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 1:15177 SNOWSHILL DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-7243
Mailing Address - Country:US
Mailing Address - Phone:903-347-0001
Mailing Address - Fax:903-347-0002
Practice Address - Street 1:321 N HIGHLAND AVE STE 105
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7371
Practice Address - Country:US
Practice Address - Phone:903-347-0001
Practice Address - Fax:903-347-0002
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51306-020207RC0200X, 207RS0012X, 207RP1001X
TXK7566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P2641OtherBLUE CROSS BLUE SHIELD
AR154334001Medicaid
TX113551908Medicaid
AR82966OtherBLUE CROSS BLUE SHIELD
TX113551905Medicaid
AR154334001Medicaid
TX333140YP79Medicare PIN
TX333140YNAQMedicare PIN
TX33140YXZ4Medicare PIN
TX113551908Medicaid
TX8P2641OtherBLUE CROSS BLUE SHIELD
TX333140YP78Medicare PIN