Healthcare Provider Details

I. General information

NPI: 1477643955
Provider Name (Legal Business Name): ISSAM MAKHOUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 CARTI WAY
LITTLE ROCK AR
72205-6523
US

IV. Provider business mailing address

PO BOX 55050
LITTLE ROCK AR
72215-5050
US

V. Phone/Fax

Practice location:
  • Phone: 15-906-3000
  • Fax:
Mailing address:
  • Phone: 501-906-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberE-3306
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberE-3306
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE-3306
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: