Healthcare Provider Details

I. General information

NPI: 1326711284
Provider Name (Legal Business Name): ATEF ADEL ELAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 E HIGHWAY 90
SIERRA VISTA AZ
85635-9110
US

IV. Provider business mailing address

4400 E BUSBY DR APT 1180O
SIERRA VISTA AZ
85635-3973
US

V. Phone/Fax

Practice location:
  • Phone: 520-678-7061
  • Fax:
Mailing address:
  • Phone: 520-678-7061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73304
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: