Healthcare Provider Details

I. General information

NPI: 1679861389
Provider Name (Legal Business Name): AMGAD MOHAMMED HALEEM AMIN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AMGAD HALEEM M.D

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

800 STANTON L YOUNG BLVD STE 3400
OKLAHOMA CITY OK
73104-5018
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9338
  • Fax:
Mailing address:
  • Phone: 405-271-4426
  • Fax: 405-271-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1017457
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number1017457
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberPENDING
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: