Provider Demographics
NPI:1679861389
Name:AMIN, AMGAD MOHAMMED HALEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:AMGAD
Middle Name:MOHAMMED HALEEM
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AMGAD
Other - Middle Name:
Other - Last Name:HALEEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:800 STANTON L YOUNG BLVD STE 3400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5018
Mailing Address - Country:US
Mailing Address - Phone:405-271-4426
Mailing Address - Fax:405-271-3074
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017457207X00000X, 207XX0004X
NYPENDING284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery