Basic Information
| Provider Information | |||||||||
| NPI: | 1467671792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHALIL | ||||||||
| FirstName: | OMER | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55050 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722155050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019063000 | ||||||||
| FaxNumber: | 5013203293 | ||||||||
| Practice Location | |||||||||
| Address1: | 8901 CARTI WAY | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019063000 | ||||||||
| FaxNumber: | 5013203293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | E-3796 | AR | N | Other Service Providers | Specialist | 207RH0003X | E-3796 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 166301001 | 05 | AR | MEDICAID |