Healthcare Provider Details

I. General information

NPI: 1366385007
Provider Name (Legal Business Name): TAREK I LAWEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 DAUPHIN ST STE 301
MOBILE AL
36606-4052
US

IV. Provider business mailing address

PO BOX 21595
BELFAST ME
04915-4112
US

V. Phone/Fax

Practice location:
  • Phone: 251-660-5930
  • Fax: 251-660-5931
Mailing address:
  • Phone: 251-243-4577
  • Fax: 251-405-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD.53782
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: