Healthcare Provider Details

I. General information

NPI: 1043958200
Provider Name (Legal Business Name): MEDIKAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505A SOUTH FWY
HOUSTON TX
77021-5928
US

IV. Provider business mailing address

3262 WESTHEIMER RD # 705
HOUSTON TX
77098-1002
US

V. Phone/Fax

Practice location:
  • Phone: 713-585-5004
  • Fax: 713-347-9264
Mailing address:
  • Phone: 713-585-5004
  • Fax: 713-347-9264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: BASIL KHALAF
Title or Position: OWNER
Credential: MD
Phone: 937-654-8484