Healthcare Provider Details

I. General information

NPI: 1700598059
Provider Name (Legal Business Name): APPLEBAUM PHYSIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N WHEELING ST
TOLEDO OH
43605-1544
US

IV. Provider business mailing address

PO BOX 1109
CROWN POINT IN
46308-1109
US

V. Phone/Fax

Practice location:
  • Phone: 419-724-1414
  • Fax:
Mailing address:
  • Phone: 708-480-2650
  • Fax: 708-575-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AHMED HASAN ELGAMAL
Title or Position: OWNER
Credential: MD
Phone: 708-480-2650