Provider Demographics
NPI:1386322188
Name:AWAD, ALI HUSSEIN (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:HUSSEIN
Last Name:AWAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:
Other - Last Name:AWAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1500 NW 4TH AVENUE
Mailing Address - Street 2:APT 213
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32603
Mailing Address - Country:US
Mailing Address - Phone:313-316-3107
Mailing Address - Fax:
Practice Address - Street 1:6500 NEWBERRY ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605
Practice Address - Country:US
Practice Address - Phone:352-333-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2024-03-11
Deactivation Date:2024-02-16
Deactivation Code:
Reactivation Date:2024-03-11
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLTRN38616207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program