Healthcare Provider Details

I. General information

NPI: 1366644049
Provider Name (Legal Business Name): ANGIE MARIE ELSHEIKH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD.
KETTERING OH
45429
US

IV. Provider business mailing address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8849
  • Fax: 937-395-8350
Mailing address:
  • Phone: 937-395-8849
  • Fax: 937-395-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35092814
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number35.092814
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: