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General NPI Number Information
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NPI Number | 1033600721
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Entity Type | Individual
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Provider Name | ABDELOUAHID SOUALA MD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 12/26/2023
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Provider Practice Location Address
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Address Line | 3113 SAEMANN AVE
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City | SHEBOYGAN
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State | WI
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Zip | 53081-1957
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Country | US
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Telephone | 920-496-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19070
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City | GREEN BAY
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State | WI
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Zip | 54307-9070
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Country | US
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Telephone | 920-496-4700
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 125.072496
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 81346-20
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License Number State | WI
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