Provider Demographics
NPI:1336109545
Name:SHENOUDA, EMAD R (MD)
Entity Type:Individual
Prefix:DR
First Name:EMAD
Middle Name:R
Last Name:SHENOUDA
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:PO BOX 7703
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50323-7703
Mailing Address - Country:US
Mailing Address - Phone:515-333-3333
Mailing Address - Fax:515-283-2020
Practice Address - Street 1:7011 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-3223
Practice Address - Country:US
Practice Address - Phone:515-333-3333
Practice Address - Fax:515-362-7933
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA33949207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1229203Medicaid