Provider Demographics
NPI:1821405739
Name:HAILEMICHAEL, ELELTA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELELTA
Middle Name:
Last Name:HAILEMICHAEL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-6436
Mailing Address - Country:US
Mailing Address - Phone:865-329-3338
Mailing Address - Fax:865-329-3333
Practice Address - Street 1:10250 67TH RD APT 2
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2670
Practice Address - Country:US
Practice Address - Phone:917-406-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR81052213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery