Provider Demographics
NPI:1821668633
Name:ELGHARBAWY, SALMAN MAHMOUD (MD)
Entity Type:Individual
Prefix:
First Name:SALMAN
Middle Name:MAHMOUD
Last Name:ELGHARBAWY
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 1:300 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1400
Mailing Address - Country:US
Mailing Address - Phone:618-536-6621
Mailing Address - Fax:
Practice Address - Street 1:704 E PARK ST APT D4
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3883
Practice Address - Country:US
Practice Address - Phone:502-389-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.077825207Q00000X
IL125077825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine