Healthcare Provider Details

I. General information

NPI: 1952959033
Provider Name (Legal Business Name): USAMA ABDALLA ELEWA MD, MSC, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 N 3RD ST
PHOENIX AZ
85004-1102
US

IV. Provider business mailing address

2610 N 3RD ST
PHOENIX AZ
85004-1102
US

V. Phone/Fax

Practice location:
  • Phone: 949-689-5167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number75955
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2024019068
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: