Healthcare Provider Details

I. General information

NPI: 1285864488
Provider Name (Legal Business Name): RISE MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W WOOSTER ST STE 107
BOWLING GREEN OH
43402-2646
US

IV. Provider business mailing address

PO BOX 72369
CLEVELAND OH
44192-0002
US

V. Phone/Fax

Practice location:
  • Phone: 419-373-7692
  • Fax:
Mailing address:
  • Phone: 419-353-7069
  • Fax: 419-353-7076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35084310
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number35084310
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35084310
License Number StateOH

VIII. Authorized Official

Name: HESHAM EL GAMAL
Title or Position: OWNER
Credential: MD
Phone: 617-216-2945