MEDICARE: DR. AHMED ELSAYED REZK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	ME105520	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208000000X	Pediatrics Physician	ME105520	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184838187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMED ELSAYED REZK MD

Provider Business Mailing Address
First Line	:	200 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4915
Country	:	US
Telephone Number	:	850-257-5524
Fax Number	:	850-257-5638

Provider Business Practice Location Address
First Line	:	200 FOREST PARK CIR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4915
Country	:	US
Telephone Number	:	850-257-5524
Fax Number	:	850-257-5638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	09/17/2021

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