Healthcare Provider Details

I. General information

NPI: 1184201402
Provider Name (Legal Business Name): ALAA MOHAMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PARKVIEW PL
LAKELAND FL
33805-4550
US

IV. Provider business mailing address

1431 SW 1ST AVE # BITZER7
OCALA FL
34471-6500
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-1300
  • Fax:
Mailing address:
  • Phone: 352-401-8311
  • Fax: 352-401-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME164655
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME164655
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: