Provider Demographics
NPI:1912234733
Name:AYMAN KARKOUTLY, M.D., PA
Entity Type:Organization
Organization Name:AYMAN KARKOUTLY, M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARKOUTLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-797-4774
Mailing Address - Street 1:4001 21ST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1101
Mailing Address - Country:US
Mailing Address - Phone:806-797-4774
Mailing Address - Fax:806-797-4377
Practice Address - Street 1:4001 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1101
Practice Address - Country:US
Practice Address - Phone:806-797-4774
Practice Address - Fax:806-797-4377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7799207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110251903Medicaid
TX110251903Medicaid