Provider Demographics
NPI:1487787602
Name:HALAC, ISIL (MD)
Entity type:Individual
Prefix:DR
First Name:ISIL
Middle Name:
Last Name:HALAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ISIL
Other - Middle Name:
Other - Last Name:MOGULTAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 RIVER POINTE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2943
Mailing Address - Country:US
Mailing Address - Phone:936-788-6060
Mailing Address - Fax:
Practice Address - Street 1:601 RIVER POINTE DR STE 120
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2943
Practice Address - Country:US
Practice Address - Phone:936-788-6060
Practice Address - Fax:219-844-9006
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064230A208000000X
TXU9539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300037734Medicaid
IN191360049OtherMEDICARE PTAN