Individual
DR. MOHAMED IBRAHIM ALI ELTOUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5454 CENTRAL AVE, SUITE A, SAINT PETERSBURG, FL 33707-6129
(727) 347-5242
(727) 347-2402
Mailing address
5454 CENTRAL AVE, SUITE A, SAINT PETERSBURG, FL 33707-6117
(727) 347-5242
(727) 347-2402
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
ME100366
FL
207RP1001X
Pulmonary Disease Physician
Primary
ME100366
FL
207RS0012X
Sleep Medicine (Internal Medicine) Physician
ME100366
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000929000
—
FL
01
—
263769693
GROUP TAX ID
FL
01
—
BJ846
MEDICARE GROUP
FL
Enumeration date
06/30/2006
Last updated
09/15/2021
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