Healthcare Provider Details

I. General information

NPI: 1548252752
Provider Name (Legal Business Name): MOHAMED SALEH MEGAHY M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E UNION AVE
LITCHFIELD IL
62056-1700
US

IV. Provider business mailing address

PO BOX 747
BELLEVILLE IL
62222-0747
US

V. Phone/Fax

Practice location:
  • Phone: 217-324-1100
  • Fax: 217-324-1103
Mailing address:
  • Phone: 618-288-2800
  • Fax: 618-288-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036066170
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: