MEDICARE: SAADI MOHY ALDEEN HALBOUNI 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	2086S0129X	Vascular Surgery Physician	45183	KY

General Provider Information

NPI Number	:	1720274533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAADI MOHY ALDEEN HALBOUNI MD

Provider Business Mailing Address
First Line	:	800 8TH AVE STE 306
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2602
Country	:	US
Telephone Number	:	682-224-3748
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 8TH AVE STE 306
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2602
Country	:	US
Telephone Number	:	682-224-3748
Fax Number	:

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

Provider Enumeration Date	:	09/15/2007
Last Update Date	:	03/16/2021

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