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General NPI Number Information
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NPI Number | 1295200632
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Entity Type | Individual
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Provider Name | KAMRAN KHALIL MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 10/12/2018
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Provider Practice Location Address
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Address Line | 384 S 33RD ST STE D
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City | MUSKOGEE
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State | OK
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Zip | 74401-5065
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Country | US
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Telephone | 918-686-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 12518 S CEDAR AVE
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City | JENKS
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State | OK
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Zip | 74037-4983
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Country | US
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Telephone | 918-841-2848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2017030862
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License Number State | MO
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