Active NPI
Islam Gamal Marawan Elmitwalli
- Pediatrics Physician
- Oklahoma City, OK
National Provider Identifier
1306692272
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 43561
- Practice address
- 1200 Childrens Ave
Oklahoma City, OK 73104-4637 - Phone
- (405) 271-4417
- NPI assigned
- Apr 30, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 43561 | OK | Primary |
Addresses
Primary practice location
1200 Childrens Ave
Oklahoma City, OK 73104-4637
Mailing address
626 Lehman St Apt 208
Columbus, OH 43206-2494
Phone (614) 477-4298
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43561 | OK | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1714435200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1306692272",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "626 LEHMAN ST APT 208",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432062494",
"telephone_number": "614-477-4298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 CHILDRENS AVE",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731044637",
"telephone_number": "405-271-4417"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELMITWALLI",
"first_name": "ISLAM",
"middle_name": "GAMAL MARAWAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-30",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OK",
"license": "43561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.