Provider Demographics
NPI:1003279761
Name:ELBANNA, AHMED (DO)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:ELBANNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2884 WELLNESS AVE, STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763
Mailing Address - Country:US
Mailing Address - Phone:386-668-2221
Mailing Address - Fax:386-668-2228
Practice Address - Street 1:2884 WELLNESS AVE, STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763
Practice Address - Country:US
Practice Address - Phone:386-668-2221
Practice Address - Fax:386-668-2228
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022515207R00000X
FLOS20018207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine