MEDICARE: DR. JAMAL MAKHOUL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	109410	MO
2	207P00000X	Emergency Medicine Physician	109410	MO
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	109410	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114904745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMAL MAKHOUL M.D.

Provider Business Mailing Address
First Line	:	4590 S LINDBERGH BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1810
Country	:	US
Telephone Number	:	314-849-7669
Fax Number	:	314-849-7670

Provider Business Practice Location Address
First Line	:	6065 HELEN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63134-2013
Country	:	US
Telephone Number	:	314-522-6410
Fax Number	:	314-522-0281

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	08/27/2024

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