MEDICARE: MOHAMED H ELNABTITY 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	207T00000X	Neurological Surgery Physician	4301079335	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

General Provider Information

NPI Number	:	1255385910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED H ELNABTITY M.D.

Provider Business Mailing Address
First Line	:	1575 RAMBLEWOOD DR
Second Line	:	SUITE 200
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6384
Country	:	US
Telephone Number	:	517-827-1800
Fax Number	:	517-827-1642

Provider Business Practice Location Address
First Line	:	1575 RAMBLEWOOD DR
Second Line	:	SUITE 200
City	:	EAST LANSING
State	:	MI
Zip	:	48823-6384
Country	:	US
Telephone Number	:	517-827-1800
Fax Number	:	517-827-1642

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	10/20/2016

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