1003102427 NPI number — DR. ZIYAD LUCKMAN KHALEEL MB CHB

Table of content: DR. ZIYAD LUCKMAN KHALEEL MB CHB (NPI 1003102427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003102427 NPI number — DR. ZIYAD LUCKMAN KHALEEL MB CHB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHALEEL
Provider First Name:
ZIYAD
Provider Middle Name:
LUCKMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MB CHB
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003102427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7693 MOUNTAIN ESTATES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COTTONWOOD HEIGHTS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84121-5421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-971-1893
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY HOSPITAL
Provider Second Line Business Practice Location Address:
30 NORTH 1900 EAST
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84132-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-4624
Provider Business Practice Location Address Fax Number:
801-585-7330
Provider Enumeration Date:
06/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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