Provider Demographics
NPI:1770662553
Name:ELBEDAWI, MAMOON M (MD)
Entity Type:Individual
Prefix:
First Name:MAMOON
Middle Name:M
Last Name:ELBEDAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6240 RASHELLE DR STE 204
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3935
Mailing Address - Country:US
Mailing Address - Phone:810-733-6300
Mailing Address - Fax:810-733-6344
Practice Address - Street 1:6240 RASHELLE DR STE 204
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3935
Practice Address - Country:US
Practice Address - Phone:810-733-6300
Practice Address - Fax:810-733-6344
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301104217207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278809800Medicaid
AF378ZMedicare PIN