Provider Demographics
NPI:1912956863
Name:INTERNAL MEDICINE OF THE TWIN CITIES
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF THE TWIN CITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-MALAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-388-6050
Mailing Address - Street 1:2503 BROADMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2987
Mailing Address - Country:US
Mailing Address - Phone:318-388-6050
Mailing Address - Fax:318-998-3017
Practice Address - Street 1:2503 BROADMOOR BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2987
Practice Address - Country:US
Practice Address - Phone:318-388-6050
Practice Address - Fax:318-998-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1446653Medicaid
LADB5602OtherRAILROAD MEDICARE
LADB5602OtherRAILROAD MEDICARE