Healthcare Provider Details

I. General information

NPI: 1477520617
Provider Name (Legal Business Name): BASEM ALKURDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 BAYSHORE BLVD
TAMPA FL
33606-2707
US

IV. Provider business mailing address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-5460
  • Fax: 813-844-1655
Mailing address:
  • Phone: 813-844-5460
  • Fax: 813-844-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00025596
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberME128074
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: