Provider Demographics
NPI:1063418374
Name:AL SHEIKHA, MOUHAMED WALID (MD)
Entity type:Individual
Prefix:
First Name:MOUHAMED
Middle Name:WALID
Last Name:AL SHEIKHA
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 1:25058 189TH ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7343
Mailing Address - Country:US
Mailing Address - Phone:563-650-6825
Mailing Address - Fax:563-326-0965
Practice Address - Street 1:2162 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5368
Practice Address - Country:US
Practice Address - Phone:563-391-1024
Practice Address - Fax:563-391-1024
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2021-08-20
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IA29965207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1125682Medicaid
IA1125682Medicaid
I14920Medicare ID - Type Unspecified