Healthcare Provider Details

I. General information

NPI: 1841429636
Provider Name (Legal Business Name): HASAN ALI KAKLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SANDY CORNER RD
EL CAMPO TX
77437-9535
US

IV. Provider business mailing address

303 SANDY CORNER RD
EL CAMPO TX
77437-9535
US

V. Phone/Fax

Practice location:
  • Phone: 979-543-6251
  • Fax:
Mailing address:
  • Phone: 979-543-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberR3538
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR3538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: