Healthcare Provider Details

I. General information

NPI: 1730101973
Provider Name (Legal Business Name): MOHAMMED KAMAL EL MALLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 SW COLLEGE RD STE 1462
OCALA FL
34474-4790
US

IV. Provider business mailing address

4414 SW COLLEGE RD UNIT 1462
OCALA FL
34474-2701
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-5183
  • Fax: 352-629-5026
Mailing address:
  • Phone: 352-622-5183
  • Fax: 352-622-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberME101225
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME101225
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: