Provider Demographics
NPI:1871896118
Name:SAM ELSHEIKH MD INC
Entity type:Organization
Organization Name:SAM ELSHEIKH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHEIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-464-1138
Mailing Address - Street 1:5565 GROSSMONT CENTER DR.
Mailing Address - Street 2:BLDG 1 STE 227
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3026
Mailing Address - Country:US
Mailing Address - Phone:619-464-1138
Mailing Address - Fax:619-464-4987
Practice Address - Street 1:5565 GROSSMONT CENTER DR.
Practice Address - Street 2:BLDG 1 STE 227
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3026
Practice Address - Country:US
Practice Address - Phone:619-464-1138
Practice Address - Fax:619-464-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A416510Medicaid
CAA29425Medicare UPIN
CA00A416510Medicaid