Provider Demographics
NPI:1245348762
Name:HAIKAL, OSAMA O (MD)
Entity type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:O
Last Name:HAIKAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 CRIMSON CANYON DR
Mailing Address - Street 2:STE 180
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0802
Mailing Address - Country:US
Mailing Address - Phone:702-734-0505
Mailing Address - Fax:702-734-3912
Practice Address - Street 1:2136 E DESERT INN RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-3247
Practice Address - Country:US
Practice Address - Phone:702-734-0505
Practice Address - Fax:702-734-3912
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCH1004OtherRAILROAD MEDICARE
NV002002765Medicaid
NVVWQBDLO1Medicare ID - Type Unspecified
NV002002765Medicaid