Provider Demographics
NPI:1386621233
Name:KANDIL, ASER M (MD)
Entity type:Individual
Prefix:
First Name:ASER
Middle Name:M
Last Name:KANDIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:MS
Mailing Address - Zip Code:39359
Mailing Address - Country:US
Mailing Address - Phone:601-625-7140
Mailing Address - Fax:601-625-7199
Practice Address - Street 1:1488 HWY 487
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:MS
Practice Address - Zip Code:39359
Practice Address - Country:US
Practice Address - Phone:601-625-7140
Practice Address - Fax:601-625-7199
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17922208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126777Medicaid
P00113126OtherRAILROAD MEDICARE
H86772Medicare UPIN