=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285575944
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHMOUD ELESAWY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2026
-----------------------------------------------------
Last Update Date | 04/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HOSPITAL DR # DC043.00
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65212-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-884-1606
-----------------------------------------------------
Fax | 573-884-4533
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4366 MARYLAND AVE APT 202
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-226-5293
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------