=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225784325
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALKAMAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2022
-----------------------------------------------------
Last Update Date | 02/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 BAXTER LN
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-4907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-486-6825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 BAXTER LN
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63017-4907
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-486-6825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. MHD DAGHOSTANI
-----------------------------------------------------
Credential | SURGICAL ASSISTANT
-----------------------------------------------------
Telephone | 407-486-6825
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------