=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699232041
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EHAB KHAMIS ELHEFNAWI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2019
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6720 BERTNER AVE
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-798-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | NORTHERN LIGHT EASTERN MAINE MEDICAL CENTER 43 WHITING HILL ROAD, STE. 300
-----------------------------------------------------
City | BREWER
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04412-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-973-5035
-----------------------------------------------------
Fax | 207-973-5042
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | MD16212
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | T5106
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------