Provider Demographics
NPI:1275528713
Name:ELKOTB, MOHAMED (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:
Last Name:ELKOTB
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 1:2875 W RAY RD STE 6-326
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-3524
Mailing Address - Country:US
Mailing Address - Phone:480-336-8951
Mailing Address - Fax:480-842-8859
Practice Address - Street 1:2875 W RAY RD STE 6-326
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-3524
Practice Address - Country:US
Practice Address - Phone:480-336-8951
Practice Address - Fax:480-842-8859
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ316632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0755180OtherBCBS
AZ861931Medicaid
AZP00184436OtherRAILROAD MEDICARE
AZ861931Medicaid
AZAZ0755180OtherBCBS