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Individual

MOHAMED ALY KHALIL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
76234
WI
208M00000X
Hospitalist Physician
036153243
IL
208M00000X
Hospitalist Physician
Primary
76234
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100184723
WI
Enumeration date
04/24/2013
Last updated
10/28/2024
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