MEDICARE: DR. AHMAD MOUSTAFA ELAKIL MD, MBA

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	207T00000X	Neurological Surgery	321532	LA

General Provider Information

NPI Number	:	1417438631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMAD MOUSTAFA ELAKIL MD, MBA

Provider Business Mailing Address
First Line	:	1200 CAMELLIA BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	705086163
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 CAMELLIA BLVD
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	705086163
Country	:	US
Telephone Number	:	337-235-7743
Fax Number	:

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

Provider Enumeration Date	:	08/25/2018
Last Update Date	:	02/17/2020

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