Healthcare Provider Details

I. General information

NPI: 1528297850
Provider Name (Legal Business Name): MUHANNAD ALQUDSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH ST STE 5A
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

301 4TH ST STE 30105
ALEXANDRIA LA
71301-8420
US

V. Phone/Fax

Practice location:
  • Phone: 318-483-1961
  • Fax: 318-483-1964
Mailing address:
  • Phone: 318-483-1961
  • Fax: 318-483-1964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number24981
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number312994
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: