Healthcare Provider Details

I. General information

NPI: 1598794026
Provider Name (Legal Business Name): MOHAMED IBRAHIM ALI ELTOUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 09/15/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5454 CENTRAL AVE SUITE A
SAINT PETERSBURG FL
33707-6129
US

IV. Provider business mailing address

5454 CENTRAL AVE SUITE A
SAINT PETERSBURG FL
33707-6117
US

V. Phone/Fax

Practice location:
  • Phone: 727-347-5242
  • Fax: 727-347-2402
Mailing address:
  • Phone: 727-347-5242
  • Fax: 727-347-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME100366
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME100366
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME100366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: