Basic Information
| Provider Information | |||||||||
| NPI: | 1568498111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELSAIDI | ||||||||
| FirstName: | GAMAL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034355270 | ||||||||
| FaxNumber: | 8034330154 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 E HOSPITAL STREET | ||||||||
| Address2: | EMERGENCY DEPT | ||||||||
| City: | MANNING | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034358463 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2006 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 200300147 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 5101011933 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 36607 | SC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11275652 | 01 | MI | CAQH | OTHER |