Healthcare Provider Details

I. General information

NPI: 1609162908
Provider Name (Legal Business Name): AMAL SADEG EL-BAKUSH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERCY PULMONOLOGY CLINIC 788 8TH AVENUE, SUITE 200
CEDAR RAPIDS IA
52401
US

IV. Provider business mailing address

3601 4TH STREET, MS 9410
LUBBOCK TX
79430-9410
US

V. Phone/Fax

Practice location:
  • Phone: 319-221-8788
  • Fax: 319-221-8787
Mailing address:
  • Phone: 806-743-3155
  • Fax: 806-743-3143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD-44420
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD-44420
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: