Healthcare Provider Details

I. General information

NPI: 1346716412
Provider Name (Legal Business Name): KARIM MAHMOUD KHAMIS MAHMOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

230 W WASHINGTON SQ FL 5
PHILADELPHIA PA
19106-3500
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-5933
  • Fax:
Mailing address:
  • Phone: 267-909-4542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberLT000372
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberLT000372
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: