Provider Demographics
NPI:1225357973
Name:ABOUELLEIL, MOURAD (MD)
Entity type:Individual
Prefix:
First Name:MOURAD
Middle Name:
Last Name:ABOUELLEIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20800
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4105
Mailing Address - Country:US
Mailing Address - Phone:888-902-1099
Mailing Address - Fax:888-402-7256
Practice Address - Street 1:1411 N FLAGLER DR STE 3800
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3426
Practice Address - Country:US
Practice Address - Phone:561-291-7182
Practice Address - Fax:561-437-2755
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME127355208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208800000XOtherROCKLEDGE HMA
FLME127355OtherFL MEDICAL LICENSE
FL208800000XOtherTAXONOMY