Provider Demographics
NPI:1871927327
Name:SHOAIB KHALIL MD PA
Entity type:Organization
Organization Name:SHOAIB KHALIL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHOAIB
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-862-7975
Mailing Address - Street 1:401 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8189
Mailing Address - Country:US
Mailing Address - Phone:817-862-7975
Mailing Address - Fax:888-909-0146
Practice Address - Street 1:401 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8189
Practice Address - Country:US
Practice Address - Phone:817-862-7975
Practice Address - Fax:888-909-0146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty