Healthcare Provider Details

I. General information

NPI: 1760943583
Provider Name (Legal Business Name): OMAR WAHID MOHAMED ELFEKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 RINEHART RD STE 2051
LAKE MARY FL
32746-4878
US

IV. Provider business mailing address

917 RINEHART RD STE 2051
LAKE MARY FL
32746-4878
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-4344
  • Fax: 321-841-5288
Mailing address:
  • Phone: 321-841-4344
  • Fax: 321-841-5288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME156941
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number32756
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: