Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 29965 | IA |
NPI | 1063418374 |
---|---|
Provider Name | Mouhamed Walid Al Sheikha |
First Address | Bettendorf, IA 52722-7343 |
Second Address | Davenport, IA 52806-5368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1125682 | (05) | IA |
G12550 | (02) |