Provider Demographics
NPI:1598794026
Name:ALI ELTOUM, MOHAMED IBRAHIM (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:IBRAHIM
Last Name:ALI ELTOUM
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 1:5454 CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-6117
Mailing Address - Country:US
Mailing Address - Phone:727-347-5242
Mailing Address - Fax:727-347-2402
Practice Address - Street 1:5454 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-6129
Practice Address - Country:US
Practice Address - Phone:727-347-5242
Practice Address - Fax:727-347-2402
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100366207RS0012X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBJ846OtherMEDICARE GROUP
FL263769693OtherGROUP TAX ID
FL000929000Medicaid
FLBJ846OtherMEDICARE GROUP