Provider Demographics
NPI:1164159414
Name:ELKHEDR, ALI ELAMIN ABBAS
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:ELAMIN ABBAS
Last Name:ELKHEDR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W KALSCHED ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1466
Mailing Address - Country:US
Mailing Address - Phone:517-914-6107
Mailing Address - Fax:
Practice Address - Street 1:1000 NORTH OAKV AVENUE
Practice Address - Street 2:MARSHFIELD
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449
Practice Address - Country:US
Practice Address - Phone:715-387-5260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program