Provider Demographics
NPI:1154388171
Name:AKL, MOHAMED NADER (MD)
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:NADER
Last Name:AKL
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 1:6632 E. BASELINE ROAD, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:480-889-2654
Mailing Address - Fax:480-699-1022
Practice Address - Street 1:6632 E. BASELINE ROAD, SUITE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-889-2654
Practice Address - Fax:480-699-1022
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ352052088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088F0040XAllopathic & Osteopathic PhysiciansUrologyUrogynecology and Reconstructive Pelvic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ094866Medicaid
AZP00367463OtherRAILROAD MEDICARE
I52876Medicare UPIN
AZ094866Medicaid