Provider Demographics
NPI:1487667481
Name:ALAOUA, MOHAMMAD DIAA (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:DIAA
Last Name:ALAOUA
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 1:1700 W STOUT ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-5000
Mailing Address - Country:US
Mailing Address - Phone:715-236-8239
Mailing Address - Fax:715-236-8449
Practice Address - Street 1:1700 W STOUT ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-5000
Practice Address - Country:US
Practice Address - Phone:715-236-8239
Practice Address - Fax:715-236-8449
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47047-020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34595400Medicaid
WI34595400Medicaid