Provider Demographics
NPI:1770539033
Name:ELMI, ABDOLALI (MD)
Entity type:Individual
Prefix:DR
First Name:ABDOLALI
Middle Name:
Last Name:ELMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-836-4042
Mailing Address - Fax:937-836-2702
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:STE 201
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-836-4042
Practice Address - Fax:937-836-2702
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000005148OtherANTHEM
OH0483089Medicaid
OH0483089Medicaid
OHEL0509542Medicare PIN