Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | TP460 | KY |
N | 111NI0900X | Internist | TP460 | KY |
Y | 207RH0003X | Hematology & Oncology | 48193 | KY |
NPI | 1003206392 |
---|---|
Provider Name | Mohamed Hegazi |
First Address | Louisville, KY 40201-0909 |
Second Address | Louisville, KY 40202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2015 |
Last Update Date | 19/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48193 | LICENSE (01) | KY |
7100385280 | (05) | KY |
K196554 | MEDICARE (01) | KY |