Healthcare Provider Details

I. General information

NPI: 1548210305
Provider Name (Legal Business Name): ABDEL H ELHOUSHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 UNIVERSITY PKWY SUITE 104
SARASOTA FL
34240-9040
US

IV. Provider business mailing address

6600 UNIVERSITY PKWY STE 104
SARASOTA FL
34240-9040
US

V. Phone/Fax

Practice location:
  • Phone: 418-002-8719
  • Fax:
Mailing address:
  • Phone: 941-800-2873
  • Fax: 941-313-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35047
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME88279
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35080939
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35080939
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME88279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: