Healthcare Provider Details

I. General information

NPI: 1871947515
Provider Name (Legal Business Name): MOHAMMAD SHAFIQ AHMAD EL-ATOUM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH ST STE B6
BUFFALO NY
14203-1126
US

IV. Provider business mailing address

462 GRIDER ST
BUFFALO NY
14215
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-4211
  • Fax: 716-859-4208
Mailing address:
  • Phone: 716-898-4806
  • Fax: 716-898-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036154974
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number326657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: