Basic Information
| Provider Information | |||||||||
| NPI: | 1902859580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELGAMAL | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7156 W 127TH ST # 300 | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084802650 | ||||||||
| FaxNumber: | 7085752876 | ||||||||
| Practice Location | |||||||||
| Address1: | 7156 W 127TH ST # 300 | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604631560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084802650 | ||||||||
| FaxNumber: | 7085752876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 208100000X | 036112679 | IL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 036112679 | 05 | IL | MEDICAID |