Provider Demographics
NPI:1144583899
Name:KANDIL, ALAA ELDIN (MD)
Entity type:Individual
Prefix:
First Name:ALAA
Middle Name:ELDIN
Last Name:KANDIL
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 120518
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0518
Mailing Address - Country:US
Mailing Address - Phone:352-708-8211
Mailing Address - Fax:855-264-9607
Practice Address - Street 1:1920 DON WICKHAM DR STE 335
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-1978
Practice Address - Country:US
Practice Address - Phone:352-708-8211
Practice Address - Fax:855-264-9607
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 115928207R00000X, 207R00000X
NJ25MA09213200207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program