Provider Demographics
NPI:1255385910
Name:ELNABTITY, MOHAMED H (MD)
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:H
Last Name:ELNABTITY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1575 RAMBLEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6384
Mailing Address - Country:US
Mailing Address - Phone:517-827-1800
Mailing Address - Fax:517-827-1642
Practice Address - Street 1:1575 RAMBLEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6384
Practice Address - Country:US
Practice Address - Phone:517-827-1800
Practice Address - Fax:517-827-1642
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2016-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301079335207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4829860Medicaid
MIMI7206014Medicare PIN
MIH17832Medicare UPIN