Provider Demographics
NPI:1477520617
Name:ALKURDI, BASEM (MD)
Entity Type:Individual
Prefix:
First Name:BASEM
Middle Name:
Last Name:ALKURDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TAMPA GENERAL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-844-5460
Mailing Address - Fax:813-844-1655
Practice Address - Street 1:409 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2707
Practice Address - Country:US
Practice Address - Phone:813-844-5460
Practice Address - Fax:813-844-1655
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025596207R00000X
FLME128074207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL106840Medicaid
AL51521858OtherBLUE CROSS BLUE SHIELD
AL051591583OtherBCBS
AL051591584OtherBCBS
AL103482Medicaid
ALP00779118OtherRAILROAD MEDICARE
AL051521858Medicaid
MS03589801Medicaid
AL051595660OtherBCBS
AL103483Medicaid
AL51521858OtherBLUE CROSS BLUE SHIELD
AL106840Medicaid
AL051595660OtherBCBS
MS03589801Medicaid