Provider Demographics
NPI:1497288088
Name:AWADALLAH, MINA (MD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:AWADALLAH
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 1:5661 RIVERSIDE DR APT 201
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-2913
Mailing Address - Country:US
Mailing Address - Phone:954-892-1134
Mailing Address - Fax:
Practice Address - Street 1:670 GLADES ROAD, SUITE 400
Practice Address - Street 2:FLORIDA ATLANTIC UNIVERSITY MEDICINE AT BOCA RATON
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-955-2570
Practice Address - Fax:561-955-2572
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME142574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine