MEDICARE: KAMAL G. KHALIL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	E4873	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8A4326	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1396939070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL G. KHALIL M.D.

Provider Business Mailing Address
First Line	:	1213 HERMANN DR STE 340
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7000
Country	:	US
Telephone Number	:	713-796-1115
Fax Number	:	713-796-2066

Provider Business Practice Location Address
First Line	:	1213 HERMANN DR STE 340
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7000
Country	:	US
Telephone Number	:	713-796-1115
Fax Number	:	713-796-2066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	04/28/2022

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