Provider Demographics
NPI:1609984111
Name:EL-FOULY, MOHAMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:EL-FOULY
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 1:1021 KARL GREIMEL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9465
Mailing Address - Country:US
Mailing Address - Phone:810-220-3766
Mailing Address - Fax:810-225-8702
Practice Address - Street 1:1021 KARL GREIMEL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9465
Practice Address - Country:US
Practice Address - Phone:810-220-3766
Practice Address - Fax:810-225-8702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010522982080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3096678Medicaid
MIBE5399680OtherDEA
MIBE5399680OtherDEA
MI3096678Medicare ID - Type Unspecified