Provider Demographics
NPI:1972502995
Name:ELHUSAIN ELNEGRES, FUAD (MD)
Entity Type:Individual
Prefix:
First Name:FUAD
Middle Name:
Last Name:ELHUSAIN ELNEGRES
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 1:5700 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2767
Mailing Address - Country:US
Mailing Address - Phone:567-585-0090
Mailing Address - Fax:567-585-0093
Practice Address - Street 1:5700 MONROE ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2767
Practice Address - Country:US
Practice Address - Phone:567-585-0090
Practice Address - Fax:567-585-0093
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000000358917OtherANTHEM
MI7736618OtherAETNA
MIP00168588OtherRRMC
MI4669613Medicaid
OH2487732Medicaid
MI04524OtherPARAMOUNT
MI24-55053OtherUHC
MI080E810120OtherBCBS MI
OH4132072Medicare PIN
OH4132071Medicare PIN
MII05755Medicare UPIN
MI4669613Medicaid
MI24-55053OtherUHC
MI000000358917OtherANTHEM