Healthcare Provider Details

I. General information

NPI: 1124048848
Provider Name (Legal Business Name): MAHMOUD ELGHOROURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 S ROCHESTER RD
ROCHESTER HILLS MI
48307-3817
US

IV. Provider business mailing address

2502 S ROCHESTER RD
ROCHESTER HILLS MI
48307-3817
US

V. Phone/Fax

Practice location:
  • Phone: 248-852-5177
  • Fax: 248-852-5424
Mailing address:
  • Phone: 248-852-5177
  • Fax: 248-852-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4301054826
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301054826
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: