Healthcare Provider Details

I. General information

NPI: 1528322674
Provider Name (Legal Business Name): MOHAMMED UMAIR ELAHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N LAKE DR
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

4425 N PORT WASHINGTON RD
GLENDALE WI
53212-1082
US

V. Phone/Fax

Practice location:
  • Phone: 414-270-4932
  • Fax: 414-585-5195
Mailing address:
  • Phone: 414-326-2218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125061903
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64424
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number64424
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036-135979
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: