Provider Demographics
NPI:1912585159
Name:ALI, MOHAMED ABOUBAKR ELSHESHTAWI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ABOUBAKR ELSHESHTAWI
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMED
Other - Middle Name:
Other - Last Name:ELSHESHTAWI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4539 LUXEMBURG CT APT 202
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5038
Mailing Address - Country:US
Mailing Address - Phone:832-834-0935
Mailing Address - Fax:
Practice Address - Street 1:180 JFK DR STE 210
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6641
Practice Address - Country:US
Practice Address - Phone:561-548-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.48278207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program