Provider Demographics
NPI:1124728332
Name:ELTAHIR, ELSADIG A
Entity type:Individual
Prefix:
First Name:ELSADIG
Middle Name:A
Last Name:ELTAHIR
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 1:3865 E FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2772
Mailing Address - Country:US
Mailing Address - Phone:480-383-9443
Mailing Address - Fax:
Practice Address - Street 1:64 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1353
Practice Address - Country:US
Practice Address - Phone:480-383-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company