MEDICARE: BARAA AL-HAFEZ 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	207T00000X	Neurological Surgery Physician	P6764	TX

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	:	1750596904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARAA AL-HAFEZ M.D

Provider Business Mailing Address
First Line	:	4601 PARK RD
Second Line	:	STE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2290
Country	:	US
Telephone Number	:	713-242-4410
Fax Number	:	713-242-4412

Provider Business Practice Location Address
First Line	:	10496 KATY FWY
Second Line	:	STE 101
City	:	HOUSTON
State	:	TX
Zip	:	77043-5106
Country	:	US
Telephone Number	:	346-571-7500
Fax Number	:	713-492-2440

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

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	11/29/2017

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