MEDICARE: RISE MEDICAL GROUP, LLC

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	35084310	OH
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	35084310	OH
3	207RP1001X	Pulmonary Disease Physician	35084310	OH

General Provider Information

NPI Number	:	1285864488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 72369
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44192-0002
Country	:	US
Telephone Number	:	419-353-7069
Fax Number	:	419-353-7076

Provider Business Practice Location Address
First Line	:	960 W WOOSTER ST STE 107
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-2646
Country	:	US
Telephone Number	:	419-373-7692
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HESHAM EL GAMAL
Credential	:	MD
Telephone Number	:	617-216-2945

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	06/17/2011

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