Provider Demographics
NPI:1982049441
Name:ELMOURSI, SEDEEK (MD)
Entity Type:Individual
Prefix:
First Name:SEDEEK
Middle Name:
Last Name:ELMOURSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SEYMOUR STREET
Mailing Address - Street 2:HARTFORD HOSPITAL NEUROLOGY DEPT
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06102-8000
Mailing Address - Country:US
Mailing Address - Phone:860-972-3621
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE STE B101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3005512084N0400X
CAA1709892084N0400X
IL0361522312084N0400X
MI43015004252084N0400X
CT641362084N0400X, 2084V0102X
NJ25MA103263002084N0400X
KYTP0562084V0102X, 2084N0400X
VA01012673342084N0400X
WI71448-202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0661422Medicaid