Provider Demographics
NPI:1285615245
Name:EL GAMAL, HESHAM H (MD)
Entity type:Individual
Prefix:
First Name:HESHAM
Middle Name:H
Last Name:EL GAMAL
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:PO BOX 72369
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:419-353-7069
Mailing Address - Fax:419-353-7076
Practice Address - Street 1:960 W WOOSTER ST
Practice Address - Street 2:SUITE 107
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2644
Practice Address - Country:US
Practice Address - Phone:419-373-7692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084310207RP1001X, 207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7169581OtherAETNA PPO PROVIDER NUMBER
CAA97968OtherMEDICAL LICENSE
CA00A979680OtherBLUE SHIELD PPO PROVIDER NUMBER
OH2492959Medicaid
CAA97968OtherMEDICAL LICENSE
CAH13138Medicare UPIN