MEDICARE: BABEK ADILI-KHAMS 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	207Q00000X	Family Medicine Physician	47390	MN

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	20250	OTHER	MS	MS LICENSE

General Provider Information

NPI Number	:	1588676811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABEK ADILI-KHAMS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5183
Second Line	:
City	:	MERIDIAN
State	:	MS
Zip	:	39302-5183
Country	:	US
Telephone Number	:	601-703-4282
Fax Number	:	601-703-4597

Provider Business Practice Location Address
First Line	:	29101 HOSPITAL RD
Second Line	:
City	:	LAKE ARROWHEAD
State	:	CA
Zip	:	92352-9706
Country	:	US
Telephone Number	:	909-336-9715
Fax Number	:	909-336-5751

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	02/12/2018

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