MEDICARE: DR. MAHMOUD S MOHAMED M.D.

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	174400000X	Specialist	4301072814	MI
2	2084N0600X	Clinical Neurophysiology Physician	35083960	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00380466	OTHER	OH	RAILROAD MEDICARE

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
2	740387	OTHER	OH	BCHP
4	000000495762	OTHER	OH	ANTHEM
5	04860	OTHER	OH	PARAMOUNT
6	7048613	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1679569222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHMOUD S MOHAMED M.D.

Provider Business Mailing Address
First Line	:	4417 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 301C
City	:	TOLEDO
State	:	OH
Zip	:	43623-3518
Country	:	US
Telephone Number	:	419-517-5333
Fax Number	:	419-517-5333

Provider Business Practice Location Address
First Line	:	4417 N HOLLAND SYLVANIA RD
Second Line	:	SUITE 301C
City	:	TOLEDO
State	:	OH
Zip	:	43623-3518
Country	:	US
Telephone Number	:	419-517-5333
Fax Number	:	419-517-5333

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	02/06/2009

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