Provider Demographics
NPI:1871194902
Name:ABDEL-AZIZ, MOHAMED WALEED (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED WALEED
Middle Name:
Last Name:ABDEL-AZIZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12814 DESPLAINES DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7841
Mailing Address - Country:US
Mailing Address - Phone:317-966-9859
Mailing Address - Fax:
Practice Address - Street 1:1501 E 29TH ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-5890
Practice Address - Country:US
Practice Address - Phone:765-282-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022055A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist