Healthcare Provider Details

I. General information

NPI: 1427267814
Provider Name (Legal Business Name): FATHALRAHMAN ELAMIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5710 CLIO RD
FLINT MI
48504-1525
US

IV. Provider business mailing address

5710 CLIO RD
FLINT MI
48504-1525
US

V. Phone/Fax

Practice location:
  • Phone: 810-785-4445
  • Fax: 810-785-4491
Mailing address:
  • Phone: 810-785-4445
  • Fax: 810-785-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-089718
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301507222
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: