Provider Demographics
NPI:1124048848
Name:ELGHOROURY, MAHMOUD (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:ELGHOROURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-3817
Mailing Address - Country:US
Mailing Address - Phone:248-852-5177
Mailing Address - Fax:248-852-5424
Practice Address - Street 1:2502 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-3817
Practice Address - Country:US
Practice Address - Phone:248-852-5177
Practice Address - Fax:248-852-5424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054826261QP2300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI330383510Medicaid
MI0638791OtherBCN/ BCBS
MIF28984OtherHAP
MI0127320OtherTOTAL HEALTHCARE MEDICAID
MI1145069OtherFIRST HEALTH
MI007894OtherMIDWEST
MI315044OtherCIGNA
MI315044OtherCIGNA
MIC4860OtherMCARE
MI007894OtherMIDWEST
MI110515OtherCARE CHOICES
MI3303835Medicaid
MIAETNAOther0927715