=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225357973
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOURAD ABOUELLEIL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2010
-----------------------------------------------------
Last Update Date | 10/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1411 N FLAGLER DR STE 3800
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33401-3426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-291-7182
-----------------------------------------------------
Fax | 561-437-2755
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20800
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-902-1099
-----------------------------------------------------
Fax | 888-402-7256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | ME127355
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------