Provider Demographics
NPI:1679569222
Name:MOHAMED, MAHMOUD S (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:S
Last Name:MOHAMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4417 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 301C
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3518
Mailing Address - Country:US
Mailing Address - Phone:419-517-5333
Mailing Address - Fax:419-517-5333
Practice Address - Street 1:4417 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 301C
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3518
Practice Address - Country:US
Practice Address - Phone:419-517-5333
Practice Address - Fax:419-517-5333
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072814174400000X
OH350839602084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2672817Medicaid
OH740387OtherBCHP
OHP00380466OtherRAILROAD MEDICARE
OH000000495762OtherANTHEM
OH04860OtherPARAMOUNT
MI7048613OtherAETNA
OHI07615Medicare UPIN
OH740387OtherBCHP