Provider Demographics
NPI:1811283740
Name:BERROU, MOHAMMED (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:BERROU
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:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:251-633-7367
Practice Address - Street 1:6701 AIRPORT BLVD STE B135
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608
Practice Address - Country:US
Practice Address - Phone:251-633-0573
Practice Address - Fax:251-633-7367
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104447207R00000X
AL34289207R00000X, 207RP1001X
PAMT198624207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL204074Medicaid
AL202820Medicaid
MS3655061OtherMS MEDICAID
AL4651430OtherUHC
AL203231Medicaid
AL511-96402OtherBCBS
AL102I2921972OtherMEDICARE
AL202657Medicaid
AL511-96403OtherBCBS
AL511-96405OtherBCBS
AL4678634OtherAETNA
AL511-96404OtherBCBS
AL9098346OtherCIGNA HC
ALP01943810OtherRR MEDICARE
ALZ34094OtherVIVA HEALTH