Healthcare Provider Details

I. General information

NPI: 1346744554
Provider Name (Legal Business Name): MOHAMED ELKAHLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NE 10TH ST STE 1G
OKLAHOMA CITY OK
73104-5417
US

IV. Provider business mailing address

2359 W BRITTON RD
OKLAHOMA CITY OK
73120-4902
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-2220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA174018
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number41048
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: