MEDICARE: EDOUARD MOUAIKEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	23932	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5579591	OTHER	AZ	AETNA US HEALTHCARE
2	1114601	OTHER	AZ	CIGNA HEALTHCARE
3	AZ0808060	OTHER	AZ	BCBS OF AZ
4	AY0705	OTHER	AZ	HEALTH NET
5	PIM13MOUAED1	OTHER	AZ	MERCYCARE
6	0400482	OTHER	AZ	UNITED HEALTHCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134120892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDOUARD MOUAIKEL M.D.

Provider Business Mailing Address
First Line	:	4530 E MUIRWOOD DR
Second Line	:	SUITE 105
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7639
Country	:	US
Telephone Number	:	480-961-2303
Fax Number	:	480-961-0419

Provider Business Practice Location Address
First Line	:	4530 E MUIRWOOD DR
Second Line	:	SUITE 105
City	:	PHOENIX
State	:	AZ
Zip	:	85048-7639
Country	:	US
Telephone Number	:	480-961-2303
Fax Number	:	480-961-0419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	01/18/2008

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Directions to “ EDOUARD MOUAIKEL M.D.” Practice Location

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