Individual
DR. IMAD BOUAKL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10835 NORTH 25TH AVENUE, SUITE 115, PHOENIX, AZ 85029-3452
(602) 789-0344
(602) 789-8389
Mailing address
10835 NORTH 25TH AVENUE, SUITE 115, PHOENIX, AZ 85029-3452
(602) 789-0344
(602) 789-8389
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
34458
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
954413-01
—
AZ
Enumeration date
03/16/2006
Last updated
11/21/2007
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