Healthcare Provider Details

I. General information

NPI: 1609714252
Provider Name (Legal Business Name): ABUBAKR ELTAYEB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 W BARNARD AVE APT 107
MILWAUKEE WI
53220-4559
US

IV. Provider business mailing address

6650 W BARNARD AVE APT 107
MILWAUKEE WI
53220-4559
US

V. Phone/Fax

Practice location:
  • Phone: 414-999-7801
  • Fax:
Mailing address:
  • Phone: 414-999-7801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberE4310139202202
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: