MEDICARE: DR. DIANE AL-ABDULJALIL MD

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	208D00000X	General Practice Physician	32462	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346458221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE AL-ABDULJALIL MD

Provider Business Mailing Address
First Line	:	4105 CROCUS LANE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4413
Country	:	US
Telephone Number	:	719-264-6271
Fax Number	:	719-264-6298

Provider Business Practice Location Address
First Line	:	4105 CROCUS LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4413
Country	:	US
Telephone Number	:	719-264-6271
Fax Number	:	719-264-6298

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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