Healthcare Provider Details

I. General information

NPI: 1568648699
Provider Name (Legal Business Name): AHMED M ELKEEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2008
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

1 HOSPITAL DR MASON EYE INSTITUTE- UNIVERSITY OF MISSOURI
COLUMBIA MO
65201-5276
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-1506
  • Fax:
Mailing address:
  • Phone: 573-882-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2016018569
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number2016018569
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: