Healthcare Provider Details

I. General information

NPI: 1609884493
Provider Name (Legal Business Name): GAMAL ELDIN ELSHAFEI M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CENTER CT
CHULA VISTA CA
91911-6617
US

IV. Provider business mailing address

2001 N GRANVILLE AVE
MUNCIE IN
47303-2110
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-5800
  • Fax: 765-284-0493
Mailing address:
  • Phone: 765-284-0493
  • Fax: 765-284-2434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GAMAL ELDIN ELSHAFEI
Title or Position: PRESIDENT
Credential: MD
Phone: 619-482-5800