Provider Demographics
NPI:1497498885
Name:ELMAHI, ELMAHI ABDELDAIEM
Entity Type:Individual
Prefix:MR
First Name:ELMAHI
Middle Name:ABDELDAIEM
Last Name:ELMAHI
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 1:661 W LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-8428
Mailing Address - Country:US
Mailing Address - Phone:602-860-7558
Mailing Address - Fax:
Practice Address - Street 1:661 W LIBERTY LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-8428
Practice Address - Country:US
Practice Address - Phone:602-860-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87-1355981171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor