Provider Demographics
NPI:1114006368
Name:REGAL PEDIATRICS
Entity Type:Organization
Organization Name:REGAL PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUND
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGHOROURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-852-5177
Mailing Address - Street 1:2502 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3817
Mailing Address - Country:US
Mailing Address - Phone:248-852-5177
Mailing Address - Fax:248-852-5424
Practice Address - Street 1:2502 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3817
Practice Address - Country:US
Practice Address - Phone:248-852-5177
Practice Address - Fax:248-852-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3303835Medicaid
MI3303835Medicaid