Healthcare Provider Details

I. General information

NPI: 1285040832
Provider Name (Legal Business Name): ZAMZAM ELGHOUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 BARRIE ST
DEARBORN MI
48126-1062
US

IV. Provider business mailing address

7922 BARRIE ST
DEARBORN MI
48126-1062
US

V. Phone/Fax

Practice location:
  • Phone: 313-205-9411
  • Fax:
Mailing address:
  • Phone: 313-205-9411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9386258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: