Basic Information
| Provider Information | |||||||||
| NPI: | 1548248214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HELAL | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 W. IRONWOOD DR. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COEUR D' ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087651455 | ||||||||
| FaxNumber: | 2086678655 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 W. IRONWOOD DR. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COEUR D' ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 83814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087651455 | ||||||||
| FaxNumber: | 2086678655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01057650A | IN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | M10083 | ID | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200437840A | 05 | IN | MEDICAID |