Provider Demographics
NPI:1114189305
Name:ELMAADAWI, AHMED ZAKRIA YOUSSEF (MD,)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:ZAKRIA YOUSSEF
Last Name:ELMAADAWI
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 1:51260 PEBBLE BEACH CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6551
Mailing Address - Country:US
Mailing Address - Phone:574-855-4607
Mailing Address - Fax:
Practice Address - Street 1:1720 BEACON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4749
Practice Address - Country:US
Practice Address - Phone:260-373-8000
Practice Address - Fax:260-373-8024
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072115A2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201162900Medicaid
IN201162900Medicaid
IN201162900Medicaid
IN000000815143OtherBCBS SOUTH BEND
MNENROLLEDMedicaid
IN000000932975OtherBCBS BMG ELKHART
IN236040132Medicare PIN