Healthcare Provider Details

I. General information

NPI: 1760279426
Provider Name (Legal Business Name): HUSAM ELDIN MAGLAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HUSAM ELDIN KHALID SALIH ALI M.D.

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date: 12/23/2025
Reactivation Date: 08/20/2026

III. Provider practice location address

250 PARK ST
BOWLING GREEN KY
42101-1760
US

IV. Provider business mailing address

250 PARK ST
BOWLING GREEN KY
42101-1760
US

V. Phone/Fax

Practice location:
  • Phone: 270-780-2680
  • Fax:
Mailing address:
  • Phone: 270-780-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: