Provider Demographics
NPI:1124596978
Name:HUSAMEDDIN ELMESALLATI MD PLLC
Entity Type:Organization
Organization Name:HUSAMEDDIN ELMESALLATI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUSAMEDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMESALLATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-789-4665
Mailing Address - Street 1:PO BOX 50224
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0224
Mailing Address - Country:US
Mailing Address - Phone:443-789-4665
Mailing Address - Fax:702-941-7222
Practice Address - Street 1:2250 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5170
Practice Address - Country:US
Practice Address - Phone:702-784-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073775110Medicaid