Provider Demographics
NPI:1972183689
Name:KAADAN, MOHAMMAD WALID
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:WALID
Last Name:KAADAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35827 HILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33541-2519
Mailing Address - Country:US
Mailing Address - Phone:813-499-6228
Mailing Address - Fax:
Practice Address - Street 1:35827 HILLBROOK AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-2519
Practice Address - Country:US
Practice Address - Phone:813-499-6228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011701363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner