Healthcare Provider Details

I. General information

NPI: 1427314020
Provider Name (Legal Business Name): KHALED Z. AQEEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPT. OF FAMILY MEDICINE
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY DEPT. OF FAMILY MEDICINE
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-5085
  • Fax: 318-675-7950
Mailing address:
  • Phone: 318-675-5085
  • Fax: 318-675-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number207921
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: