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General NPI Number Information
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NPI Number | 1245600923
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Entity Type | Individual
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Provider Name | ELSHEIKH MAMOUN ELSHEIKH ABDELRAHIM
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Gender | Male
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 07/11/2024
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Provider Practice Location Address
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Address Line | 499 GLOSTER CREEK VLG STE A2
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City | TUPELO
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State | MS
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Zip | 38801-4749
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Country | US
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Telephone | 662-620-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 808 VARSITY DR
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City | TUPELO
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State | MS
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Zip | 38801-4613
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Country | US
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Telephone | 662-377-3204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 31992
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License Number State | MS
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