Healthcare Provider Details

I. General information

NPI: 1043031388
Provider Name (Legal Business Name): MOHAMMAD EL SIBAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date: 10/21/2024
Reactivation Date: 10/31/2024

III. Provider practice location address

1919 E THOMAS RD
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

630 W 168TH ST # MC28
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-1000
  • Fax:
Mailing address:
  • Phone: 646-317-1619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number125089055
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125089055
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: