Healthcare Provider Details

I. General information

NPI: 1841240421
Provider Name (Legal Business Name): NUHAD AFIF KULAYLAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 SHADELAND AVE
DREXEL HILL PA
19026-1913
US

IV. Provider business mailing address

1349 N MOUNT AUBURN RD
CAPE GIRARDEAU MO
63701-1727
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-9564
  • Fax: 573-334-1879
Mailing address:
  • Phone: 573-334-9564
  • Fax: 573-334-1879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberE-3226
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036-107478
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2002006960
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier481120
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerHEALTHLINK
# 2
Identifier5M291
Identifier TypeOTHER
Identifier StateAR
Identifier IssuerBLUE CROSS BLUE SHIELD
# 3
Identifier110237678
Identifier TypeOTHER
Identifier State
Identifier IssuerRAIL ROAD MEDICARE
# 4
Identifier096560
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTH ALLIANCE
# 5
Identifier205990708
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 6
Identifier158646
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerBLUE CROSS BLUE SHIELD
# 7
Identifier205990716
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 8
Identifier148096001
Identifier TypeMEDICAID
Identifier StateAR
Identifier Issuer
# 9
Identifier2104551
Identifier TypeOTHER
Identifier State
Identifier IssuerCOVENTRY HEALTHCARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: