Provider Demographics
NPI:1578758835
Name:NEUROPRO INC
Entity Type:Organization
Organization Name:NEUROPRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:ESSAM
Authorized Official - Last Name:ELKOTB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-524-7701
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:
Mailing Address - Fax:
Practice Address - Street 1:5130 W THUNDERBIRD RD
Practice Address - Street 2:SUITE #3
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4879
Practice Address - Country:US
Practice Address - Phone:602-993-5209
Practice Address - Fax:602-993-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31663204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I03758Medicare UPIN
108953Medicare PIN