Provider Demographics
NPI:1902859580
Name:ELGAMAL, AHMED H (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:H
Last Name:ELGAMAL
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:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1109
Mailing Address - Country:US
Mailing Address - Phone:708-480-2650
Mailing Address - Fax:708-575-2876
Practice Address - Street 1:7156 W 127TH ST # 300
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1560
Practice Address - Country:US
Practice Address - Phone:708-480-2650
Practice Address - Fax:708-575-2876
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112679208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112679Medicaid
I52415Medicare UPIN