Provider Demographics
NPI:1588862312
Name:MAKHOUL, WASEEM (MD)
Entity type:Individual
Prefix:
First Name:WASEEM
Middle Name:
Last Name:MAKHOUL
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 1:10365 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5741
Mailing Address - Country:US
Mailing Address - Phone:503-208-9144
Mailing Address - Fax:503-698-1900
Practice Address - Street 1:10365 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 245
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5741
Practice Address - Country:US
Practice Address - Phone:503-208-9144
Practice Address - Fax:503-698-1900
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD150278207K00000X
WAMD60113845207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology