Provider Demographics
NPI:1740267053
Name:KHALIFA, AHMED ANWAR (MD)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:ANWAR
Last Name:KHALIFA
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 1:6524 SAN FELIPE
Mailing Address - Street 2:#95
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:713-355-1500
Mailing Address - Fax:
Practice Address - Street 1:4120 SOUTHWEST FWY
Practice Address - Street 2:STE 230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7339
Practice Address - Country:US
Practice Address - Phone:713-355-1500
Practice Address - Fax:713-629-1945
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7441208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
8B1710Medicare ID - Type Unspecified
E36553Medicare UPIN