MEDICARE: DR. AHMED T ABDELAL 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	EO152	AR

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	:	1548265572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMED T ABDELAL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1006
Second Line	:
City	:	MABELVALE
State	:	AR
Zip	:	72103-1006
Country	:	US
Telephone Number	:	501-455-7021
Fax Number	:	501-455-7047

Provider Business Practice Location Address
First Line	:	11321 INTERSTATE 30
Second Line	:	STE 308
City	:	LITTLE ROCK
State	:	AR
Zip	:	72209-7067
Country	:	US
Telephone Number	:	501-455-7021
Fax Number	:	501-455-7047

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	12/21/2009

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