Provider Demographics
NPI:1346271830
Name:EL-SHIEKH, REDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:REDA
Middle Name:A
Last Name:EL-SHIEKH
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 1:1320 WOODLAND DR, STE A
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-769-2929
Mailing Address - Fax:270-769-0344
Practice Address - Street 1:1320 WOODLAND DR
Practice Address - Street 2:STE A
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-769-2929
Practice Address - Fax:270-769-0344
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0696502Medicare PIN
KYG62454Medicare UPIN