Provider Demographics
NPI:1023495413
Name:ELKHETALI, ABDURAHMAN SAID
Entity type:Individual
Prefix:DR
First Name:ABDURAHMAN
Middle Name:SAID
Last Name:ELKHETALI
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 1:101 WILDBROOK LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-6123
Mailing Address - Country:US
Mailing Address - Phone:323-877-9126
Mailing Address - Fax:
Practice Address - Street 1:1400 E BOULDER ST STE 700
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5533
Practice Address - Country:US
Practice Address - Phone:719-365-7300
Practice Address - Fax:719-365-7301
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6962084N0400X
CODR.00635372084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100099071Medicaid