Individual
KHALED HAMMOUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
975 MEZZANINE DR STE C, LAFAYETTE, IN 47905-8635
(765) 446-5220
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01067405A
IN
2084N0600X
Clinical Neurophysiology Physician
01067405A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000668722
ANTHEM
IN
05
—
200978960
—
IN
Enumeration date
06/05/2007
Last updated
05/08/2024
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