Provider Demographics
NPI:1811973902
Name:ELSAYED, M. HANY FATHY (MD)
Entity type:Individual
Prefix:DR
First Name:M. HANY
Middle Name:FATHY
Last Name:ELSAYED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAMED HANY
Other - Middle Name:FATHY
Other - Last Name:ELSAYED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10611 S WINSTON CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-6804
Mailing Address - Country:US
Mailing Address - Phone:918-813-2431
Mailing Address - Fax:
Practice Address - Street 1:10611 S WINSTON CT
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-6804
Practice Address - Country:US
Practice Address - Phone:918-813-2431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63477208000000X, 2080N0001X
IN01087122A2080N0001X, 320800000X
CAA501012080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
F46218Medicare UPIN