Provider Demographics
NPI:1275528713
Name:ELKOTB, MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:ELKOTB
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 1:17721 N 53RD LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5360
Mailing Address - Country:US
Mailing Address - Phone:602-993-9500
Mailing Address - Fax:602-993-5209
Practice Address - Street 1:5130 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 03
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4879
Practice Address - Country:US
Practice Address - Phone:602-993-9500
Practice Address - Fax:602-993-5209
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ316632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ861931Medicaid
AZAZ0755180OtherBCBS
AZP00184436OtherRAILROAD MEDICARE
AZ861931Medicaid
AZAZ0755180OtherBCBS