MEDICARE: DR. MAHMOUD ELGHOROURY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	4301054826	MI
2	208000000X	Pediatrics Physician	4301054826	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0638791	OTHER	MI	BCN/ BCBS
3	F28984	OTHER	MI	HAP
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1145069	OTHER	MI	FIRST HEALTH
6	007894	OTHER	MI	MIDWEST
7	315044	OTHER	MI	CIGNA

General Provider Information

NPI Number	:	1124048848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHMOUD ELGHOROURY M.D.

Provider Business Mailing Address
First Line	:	2502 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3817
Country	:	US
Telephone Number	:	248-852-5177
Fax Number	:	248-852-5424

Provider Business Practice Location Address
First Line	:	2502 S ROCHESTER RD
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-3817
Country	:	US
Telephone Number	:	248-852-5177
Fax Number	:	248-852-5424

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	06/10/2019

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