Individual
KHALID S KAHOOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
200 THEDA CLARK PLAZA, SUITE 110, NEENAH, WI 54956-2790
(920) 751-8666
(920) 751-0288
Mailing address
200 THEDA CLARK PLAZA, SUITE 110, NEENAH, WI 54956-2790
(920) 751-8666
(920) 751-0288
Taxonomy
Speciality
Code
Description
License number
State
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
6519320
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
K400293985
MEDICARE PTAN
WI
Enumeration date
03/24/2011
Last updated
12/11/2017
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