Provider Demographics
NPI:1396730230
Name:AL KHADOUR, HUSSAMADDIN (MD)
Entity type:Individual
Prefix:DR
First Name:HUSSAMADDIN
Middle Name:
Last Name:AL KHADOUR
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 1:616 CYPRESS CREEK PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3025
Mailing Address - Country:US
Mailing Address - Phone:281-364-8787
Mailing Address - Fax:713-636-9088
Practice Address - Street 1:616 CYPRESS CREEK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3025
Practice Address - Country:US
Practice Address - Phone:281-364-8787
Practice Address - Fax:713-636-9088
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080648103OtherEPSDT
TX157218201Medicaid
TX8J3438OtherBCBS OF TX
TX8A4353Medicare PIN
TXG92771Medicare UPIN