Healthcare Provider Details

I. General information

NPI: 1205383023
Provider Name (Legal Business Name): ISMAIL SIDKY MOHAMED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF PAEDIATRICS NEUROLOGY DIVISION CHILDREN'S HOSPITAL OF ALABAMA
BIRMINGHAM AL
35249-6539
US

IV. Provider business mailing address

DEPARTMENT OF PAEDIATRICS NEUROLOGY DIVISION CHILDREN'S HOSPITAL OF ALABAMA
BIRMINGHAM AL
35249-6539
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-7850
  • Fax:
Mailing address:
  • Phone: 205-996-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number35404
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number35404
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number35404
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number35404
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: