MEDICARE: ACILLE ADHAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	TRN11605	FL
2	208000000X	Pediatrics Physician	111128	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659563591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ACILLE ADHAL M.D.

Provider Business Mailing Address
First Line	:	102 MEDICAL CENTER DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4907
Country	:	US
Telephone Number	:	850-913-1666
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 MEDICAL CENTER DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4907
Country	:	US
Telephone Number	:	850-913-1666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	03/17/2025

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Directions to “ ACILLE ADHAL M.D.” Practice Location

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