Provider Demographics
NPI:1427256643
Name:AL ALOUL, BASEL (MD, DO, MB, BCH)
Entity type:Individual
Prefix:
First Name:BASEL
Middle Name:
Last Name:AL ALOUL
Suffix:
Gender:M
Credentials:MD, DO, MB, BCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 OLD CAMP RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1762
Mailing Address - Country:US
Mailing Address - Phone:352-633-1966
Mailing Address - Fax:352-633-1969
Practice Address - Street 1:1050 OLD CAMP RD
Practice Address - Street 2:SUITE 270
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:352-633-1966
Practice Address - Fax:352-633-1969
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME 120823207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013291300Medicaid
FLME120823OtherFL STATE LICENSE
FLME120823OtherFL STATE LICENSE