Healthcare Provider Details

I. General information

NPI: 1417438631
Provider Name (Legal Business Name): AHMAD MOUSTAFA ELAKIL MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AHMED MUSTAFA ALAQEEL MD,MBA

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CAMELLIA BLVD
LAFAYETTE LA
705086163
US

IV. Provider business mailing address

1200 CAMELLIA BLVD
LAFAYETTE LA
705086163
US

V. Phone/Fax

Practice location:
  • Phone: 337-235-7743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery
License Number321532
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: