Provider Demographics
NPI:1497722979
Name:ALQULALI, MONA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:S
Last Name:ALQULALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4532
Mailing Address - Country:US
Mailing Address - Phone:563-241-4000
Mailing Address - Fax:563-241-4004
Practice Address - Street 1:507 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732
Practice Address - Country:US
Practice Address - Phone:563-241-4000
Practice Address - Fax:563-241-4004
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33032IOWA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0190728Medicaid
IA0190728Medicaid
H10541Medicare UPIN
05526Medicare PIN