Provider Demographics
NPI:1225357973
Name:ABOUELLEIL, MOURAD (MD)
Entity Type:Individual
Prefix:
First Name:MOURAD
Middle Name:
Last Name:ABOUELLEIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7227 N US HIGHWAY 1
Mailing Address - Street 2:STE 220
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-5034
Mailing Address - Country:US
Mailing Address - Phone:321-637-7655
Mailing Address - Fax:321-690-6576
Practice Address - Street 1:7227 N US HIGHWAY 1
Practice Address - Street 2:SUITE 220
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-5020
Practice Address - Country:US
Practice Address - Phone:321-637-7655
Practice Address - Fax:321-690-6576
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME127355208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208800000XOtherROCKLEDGE HMA
FL208800000XOtherTAXONOMY
FLME127355OtherFL MEDICAL LICENSE