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NPI Code Detail

MEDICARE: APPLEBAUM PHYSIATRY PLLC

MEDICARE: APPLEBAUM PHYSIATRY PLLC
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
1363LG0600XGerontology Nurse Practitioner
2363A00000XPhysician Assistant
3363AM0700XMedical Physician Assistant
4363LF0000XFamily Nurse Practitioner
5208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1700598059
Entity Type Code : Organization
Provider Name (Legal Business Name) : APPLEBAUM PHYSIATRY PLLC
Provider Business Mailing Address
First Line : PO BOX 1109
Second Line :
City : CROWN POINT
State : IN
Zip : 46308-1109
Country : US
Telephone Number : 708-480-2650
Fax Number : 708-575-2876
Provider Business Practice Location Address
First Line : 131 N WHEELING ST
Second Line :
City : TOLEDO
State : OH
Zip : 43605-1544
Country : US
Telephone Number : 419-724-1414
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. AHMED HASAN ELGAMAL
Credential : MD
Telephone Number : 708-480-2650
Provider Enumeration Date : 12/19/2022
Last Update Date : 11/15/2024

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