Provider Demographics
NPI:1164421251
Name:YILMA, ZELALEM (MD)
Entity Type:Individual
Prefix:DR
First Name:ZELALEM
Middle Name:
Last Name:YILMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6859 E REMBRANDT AVE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-3628
Mailing Address - Country:US
Mailing Address - Phone:480-632-1577
Mailing Address - Fax:480-632-1574
Practice Address - Street 1:6859 E REMBRANDT AVE
Practice Address - Street 2:SUITE 117
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85212-3628
Practice Address - Country:US
Practice Address - Phone:480-632-1577
Practice Address - Fax:480-632-1574
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25431207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391384Medicaid
AZZ20034Medicare PIN
AZ060049459Medicare PIN
AZ391384Medicaid
AZZ21240Medicare PIN