Provider Demographics
NPI:1467573436
Name:GOMAA, AHMED S
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:S
Last Name:GOMAA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRACKLEY LN
Mailing Address - Street 2:SOUTH BARRINGTON
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-6128
Mailing Address - Country:US
Mailing Address - Phone:847-776-6822
Mailing Address - Fax:847-705-9838
Practice Address - Street 1:6 BRACKLEY LN
Practice Address - Street 2:SOUTH BARRINGTON
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-6128
Practice Address - Country:US
Practice Address - Phone:847-776-6822
Practice Address - Fax:847-705-9838
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000112247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other