Provider Demographics
NPI:1730101973
Name:EL MALLAH, MOHAMMED KAMAL (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:KAMAL
Last Name:EL MALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1500 SE MAGNOLIA EXT STE 101
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4452
Mailing Address - Country:US
Mailing Address - Phone:352-622-5183
Mailing Address - Fax:352-622-2720
Practice Address - Street 1:4414 SW COLLEGE RD STE 1462
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4790
Practice Address - Country:US
Practice Address - Phone:352-622-5183
Practice Address - Fax:352-629-5026
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101225207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000082300Medicaid
FL30620OtherBLUE CROSS AND BLUE SHIELD OF FL
FLAL915YMedicare PIN
FLAL915ZMedicare PIN