Provider Demographics
NPI:1588451884
Name:ELSHISHTAWY, MOHAMED O
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:O
Last Name:ELSHISHTAWY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13955 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5453
Mailing Address - Country:US
Mailing Address - Phone:734-855-4490
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:13955 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5453
Practice Address - Country:US
Practice Address - Phone:734-855-4490
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist