Healthcare Provider Details

I. General information

NPI: 1124348263
Provider Name (Legal Business Name): ABRAHAM AKRAM ASSAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CORAL RIDGE AVE
CORALVILLE IA
52241-4708
US

IV. Provider business mailing address

2700 CORAL RIDGE AVE
CORALVILLE IA
52241-4708
US

V. Phone/Fax

Practice location:
  • Phone: 319-626-2391
  • Fax:
Mailing address:
  • Phone: 319-626-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR-8850
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberME119228
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number40021
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: