Provider Demographics
NPI:1740465400
Name:AHMED E ELSEHETY MD, PA
Entity type:Organization
Organization Name:AHMED E ELSEHETY MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELSEHETY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-329-8200
Mailing Address - Street 1:929 N GALLOWAY AVE
Mailing Address - Street 2:102
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2476
Mailing Address - Country:US
Mailing Address - Phone:972-329-8200
Mailing Address - Fax:972-329-8202
Practice Address - Street 1:929 N GALLOWAY AVE
Practice Address - Street 2:102
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2476
Practice Address - Country:US
Practice Address - Phone:972-329-8200
Practice Address - Fax:972-329-8202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3093174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152590901Medicaid
TX2084N0400XOtherTAXONOMY
TX152590901Medicaid
TX00587TMedicare PIN