Provider Demographics
NPI:1356427512
Name:ELSHEIKH, HUSAM (MD)
Entity type:Individual
Prefix:
First Name:HUSAM
Middle Name:
Last Name:ELSHEIKH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HUSAM
Other - Middle Name:
Other - Last Name:ELSHEIKH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5565 GROSSMONT CENTER DR
Mailing Address - Street 2:BLDG 1, STE 227
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3020
Mailing Address - Country:US
Mailing Address - Phone:619-464-1138
Mailing Address - Fax:619-464-4987
Practice Address - Street 1:5565 GROSSMONT CENTER DR
Practice Address - Street 2:BLDG 1, STE 227
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3020
Practice Address - Country:US
Practice Address - Phone:619-464-1138
Practice Address - Fax:619-464-4987
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41651207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A416510Medicaid
CAA29425Medicare UPIN
CA00A416510Medicaid