MEDICARE: MOHAMED KHALED EZZ ELDIN 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	390200000X	Student in an Organized Health Care Education/Training Program
2	208D00000X	General Practice Physician	MD.49919	AL
3	208M00000X	Hospitalist Physician	W1413	TX
4	207R00000X	Internal Medicine Physician	W1413	TX

General Provider Information

NPI Number	:	1952097388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMED KHALED EZZ ELDIN MD

Provider Business Mailing Address
First Line	:	921 GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2501
Country	:	US
Telephone Number	:	713-242-3768
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 GESSNER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2501
Country	:	US
Telephone Number	:	713-242-3768
Fax Number	:

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

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	05/20/2026

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