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General NPI Number Information
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NPI Number | 1609304617
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Entity Type | Individual
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Provider Name | ADAM SOUHAIL ALDAHAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2017
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 5053 S CONGRESS AVE STE 204
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City | LAKE WORTH
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State | FL
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Zip | 33461-4706
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Country | US
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Telephone | 561-969-7300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 43
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City | MINNEAPOLIS
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State | MN
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Zip | 55440-0043
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Country | US
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Telephone | 612-262-1166
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Fax | 612-262-9035
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 65072
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | ME164498
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME164498
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License Number State | FL
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