Provider Demographics
NPI:1063409282
Name:MAKHOUL, NIDAL (MD FACC FACP)
Entity type:Individual
Prefix:
First Name:NIDAL
Middle Name:
Last Name:MAKHOUL
Suffix:
Gender:M
Credentials:MD FACC FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 TOM MILLER ROAD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1252
Mailing Address - Country:US
Mailing Address - Phone:518-563-2404
Mailing Address - Fax:518-563-4033
Practice Address - Street 1:52 TOM MILLER ROAD
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1252
Practice Address - Country:US
Practice Address - Phone:518-563-2404
Practice Address - Fax:518-563-4033
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYE0021551207RC0000X
NY238355207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02041707Medicaid
NYBM5958751OtherDEA
NYBB1979Medicare ID - Type Unspecified
NY02041707Medicaid