Basic Information
| Provider Information | |||||||||
| NPI: | 1972647311 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMALEDDINE | ||||||||
| FirstName: | WAEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33044 HWY 27 | ||||||||
| Address2: | |||||||||
| City: | HAINES CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338447621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634224977 | ||||||||
| FaxNumber: | 8634227786 | ||||||||
| Practice Location | |||||||||
| Address1: | 33044 HWY 27 | ||||||||
| Address2: | |||||||||
| City: | HAINES CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338447621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634224977 | ||||||||
| FaxNumber: | 8634227786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 12/14/2014 | ||||||||
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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 | 207Q00000X | ME62749 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2519097-00 | 05 | FL | MEDICAID | 080108263 | 01 | FL | RAILROAD MEDICARE | OTHER | 18170 | 01 | FL | BCBS | OTHER | 6871531 | 01 | FL | CIGNA | OTHER |