Provider Demographics
NPI:1972613057
Name:ABOYOUSSEF, MOHAMED M (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:M
Last Name:ABOYOUSSEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:40 FORTENBERRY RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3616
Mailing Address - Country:US
Mailing Address - Phone:321-264-1135
Mailing Address - Fax:321-453-4188
Practice Address - Street 1:40 FORTENBERRY RD
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3616
Practice Address - Country:US
Practice Address - Phone:321-453-0779
Practice Address - Fax:321-453-4188
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140157207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HII23504Medicare UPIN
HIH101124Medicare PIN