Provider Demographics
NPI:1922024660
Name:ABDELAZIZ, MOHAMED IBRAHIM (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:IBRAHIM
Last Name:ABDELAZIZ
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 1:620 EICHENFELD DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5973
Mailing Address - Country:US
Mailing Address - Phone:813-654-3200
Mailing Address - Fax:813-653-0232
Practice Address - Street 1:620 EICHENFELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5973
Practice Address - Country:US
Practice Address - Phone:813-654-3200
Practice Address - Fax:813-653-0232
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46054207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045781700Medicaid
FLE00866Medicare UPIN
FL02781Medicare ID - Type Unspecified