Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 125079126 | IL |
NPI | 1164198420 |
---|---|
Provider Name | Moustafa Mohamed A Elziny |
First Address | Chicago, IL 60612-5584 |
Second Address | Chicago, IL 60612-5584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2021 |
Last Update Date | 17/08/2021 |