Provider Demographics
NPI:1942563820
Name:ABU SPEITAN, MOHANAD HAMDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHANAD
Middle Name:HAMDAN
Last Name:ABU SPEITAN
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 1:3926 NEW VISION DR
Mailing Address - Street 2:BLDG H
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1712
Mailing Address - Country:US
Mailing Address - Phone:260-266-8213
Mailing Address - Fax:260-458-5658
Practice Address - Street 1:850 5TH AVE E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-7419
Practice Address - Country:US
Practice Address - Phone:205-348-1770
Practice Address - Fax:205-348-5145
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA88236207R00000X
IN01074906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine