Provider Demographics
NPI:1477282770
Name:ALWAKEEDI, ADEL MOHAMMED
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:MOHAMMED
Last Name:ALWAKEEDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1797
Mailing Address - Country:US
Mailing Address - Phone:502-852-1603
Mailing Address - Fax:
Practice Address - Street 1:501 E BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1797
Practice Address - Country:US
Practice Address - Phone:502-852-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020038736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine