Provider Demographics
NPI:1215434485
Name:MAHGOUB, MOHAMMED YASIN IBRAHIM (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:YASIN IBRAHIM
Last Name:MAHGOUB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:770 W GRANADA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5179
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 CYPRESS EDGE DR STE 201
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8454
Practice Address - Country:US
Practice Address - Phone:386-231-4017
Practice Address - Fax:386-359-2943
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME174918207RN0300X
MN73754207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology