Provider Demographics
NPI:1326236712
Name:AWAD, KHALED (MD)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:AWAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHALED
Other - Middle Name:ESMAEEL
Other - Last Name:AWAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4316 JAMES CASEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1157
Mailing Address - Country:US
Mailing Address - Phone:512-807-3150
Mailing Address - Fax:
Practice Address - Street 1:4316 JAMES CASEY ST STE C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1157
Practice Address - Country:US
Practice Address - Phone:512-807-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084536207R00000X
TXV2070207RC0000X, 207RC0001X
MO2015028191207RC0001X
PAMD442730207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1326236712Medicaid
MO147540052Medicare PIN
MOMA1160058Medicare PIN