Healthcare Provider Details

I. General information

NPI: 1588617633
Provider Name (Legal Business Name): NAWAL R. ABUL-KHOUDOUD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 HIGHWAY 59 S
THIEF RIVER FALLS MN
56701-4331
US

IV. Provider business mailing address

1720 HIGHWAY 59 S
THIEF RIVER FALLS MN
56701-4331
US

V. Phone/Fax

Practice location:
  • Phone: 218-681-4747
  • Fax: 218-671-2595
Mailing address:
  • Phone: 218-681-4747
  • Fax: 218-671-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45503
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: