Healthcare Provider Details

I. General information

NPI: 1285615245
Provider Name (Legal Business Name): HESHAM H EL GAMAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 W WOOSTER ST SUITE 107
BOWLING GREEN OH
43402-2644
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 TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number35.084310
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number35.084310
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number35.084310
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: