Basic Information
| Provider Information | |||||||||
| NPI: | 1811283740 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERROU | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Practice Location | |||||||||
| Address1: | 6701 AIRPORT BLVD STE B135 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2011 | ||||||||
| LastUpdateDate: | 05/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301104447 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 34289 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MT198624 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 34289 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 204074 | 05 | AL | MEDICAID | 202820 | 05 | AL | MEDICAID | 3655061 | 01 | MS | MS MEDICAID | OTHER | 4651430 | 01 | AL | UHC | OTHER | 203231 | 05 | AL | MEDICAID | 511-96402 | 01 | AL | BCBS | OTHER | 102I2921972 | 01 | AL | MEDICARE | OTHER | 202657 | 05 | AL | MEDICAID | 511-96403 | 01 | AL | BCBS | OTHER | 511-96405 | 01 | AL | BCBS | OTHER | 4678634 | 01 | AL | AETNA | OTHER | 511-96404 | 01 | AL | BCBS | OTHER | 9098346 | 01 | AL | CIGNA HC | OTHER | P01943810 | 01 | AL | RR MEDICARE | OTHER | Z34094 | 01 | AL | VIVA HEALTH | OTHER |