Organization
EGYPTIAN SPINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AHMED SALEM MOHAMED MD (OWNER)
(618) 231-6121
Entity
Organization
Contact information
Practice address
412 S 34TH ST STE 101, MOUNT VERNON, IL 62864-6021
(618) 231-6121
Mailing address
412 S 34TH ST STE 101, MOUNT VERNON, IL 62864-6021
(618) 231-6121
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
036.136254
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036136254
—
IL
Enumeration date
10/31/2015
Last updated
11/30/2020
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