Basic Information
Provider Information
NPI: 1194274779
EntityType: 2
ReplacementNPI:  
OrganizationName: ELAMIN MEDICAL PC
LastName:  
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Credential:  
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Mailing Information
Address1: PO BOX 1313
Address2:  
City: YUMA
State: AZ
PostalCode: 853662359
CountryCode: US
TelephoneNumber: 9283179100
FaxNumber: 9283179300
Practice Location
Address1: 2400 S AVENUE A
Address2:  
City: YUMA
State: AZ
PostalCode: 853647127
CountryCode: US
TelephoneNumber: 9283442000
FaxNumber: 9283179300
Other Information
ProviderEnumerationDate: 09/24/2016
LastUpdateDate: 09/24/2016
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: EL AMIN
AuthorizedOfficialFirstName: MOHEMED
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 9283442000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X52575AZY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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