Healthcare Provider Details

I. General information

NPI: 1669673216
Provider Name (Legal Business Name): MOHAMED HOSNY ELGAMAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 VALPARAISO DR
MUNSTER IN
46321-4040
US

IV. Provider business mailing address

1040 SIERRA DR STE 400
GREENWOOD IN
46143-7241
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5800
  • Fax: 219-836-7593
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01073821A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberTD121120
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD447654
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301089619
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: