Healthcare Provider Details

I. General information

NPI: 1134350523
Provider Name (Legal Business Name): MOHAMED AMIN KADOURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 HUGHES DR STE 920
TOLEDO OH
43606-5116
US

IV. Provider business mailing address

2109 HUGHES DR STE 920
TOLEDO OH
43606-5116
US

V. Phone/Fax

Practice location:
  • Phone: 304-479-2650
  • Fax: 419-479-2655
Mailing address:
  • Phone: 419-479-2650
  • Fax: 419-479-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT194535
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP85884
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25748
License Number StateWV
# 5
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35.131399
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: