Healthcare Provider Details

I. General information

NPI: 1134651979
Provider Name (Legal Business Name): MAI G AL KHADEM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 PIERCE ST STE 420
SIOUX CITY IA
51104-3796
US

IV. Provider business mailing address

2730 PIERCE ST STE 420
SIOUX CITY IA
51104-3796
US

V. Phone/Fax

Practice location:
  • Phone: 712-234-8725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD-56333
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: