Provider Demographics
NPI:1669902052
Name:ELAGAMY, ABD-EL-KHALEK (DO)
Entity type:Individual
Prefix:
First Name:ABD-EL-KHALEK
Middle Name:
Last Name:ELAGAMY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29200 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2228
Mailing Address - Country:US
Mailing Address - Phone:734-523-1785
Mailing Address - Fax:734-523-1064
Practice Address - Street 1:29200 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2228
Practice Address - Country:US
Practice Address - Phone:734-523-1050
Practice Address - Fax:734-523-1064
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025263208000000X
OH34.014497208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics