Provider Demographics
NPI:1659512366
Name:WASSEF, MOUNIR MAKRAM (DO)
Entity Type:Individual
Prefix:DR
First Name:MOUNIR
Middle Name:MAKRAM
Last Name:WASSEF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12788 FOREST HILL BLVD STE 1004
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4703
Mailing Address - Country:US
Mailing Address - Phone:561-246-1791
Mailing Address - Fax:
Practice Address - Street 1:12788 FOREST HILL BLVD STE 1004
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4703
Practice Address - Country:US
Practice Address - Phone:561-246-1791
Practice Address - Fax:561-469-6456
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10492207R00000X
FLOS10492207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14JU9OtherBLUE CROSS