Healthcare Provider Details

I. General information

NPI: 1659684579
Provider Name (Legal Business Name): IBA AL WOHOUSH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 TURKEY LAKE RD STE 108
ORLANDO FL
32819-8015
US

IV. Provider business mailing address

9430 TURKEY LAKE RD STE 108
ORLANDO FL
32819-8015
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-1039
  • Fax: 407-425-2347
Mailing address:
  • Phone: 407-423-1039
  • Fax: 407-425-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberQ7628
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01097362A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME143746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: