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General NPI Number Information
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NPI Number | 1821405739
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Entity Type | Individual
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Provider Name | ELELTA HAILEMICHAEL DPM
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Gender | Female
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 10250 67TH RD APT 2
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City | FOREST HILLS
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State | NY
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Zip | 11375-2670
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Country | US
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Telephone | 917-406-5716
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Fax |
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Provider Business Mailing Address
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Address Line | 2725 ASBURY RD
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City | KNOXVILLE
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State | TN
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Zip | 37914-6436
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Country | US
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Telephone | 865-329-3338
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Fax | 865-329-3333
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | R81052
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License Number State | NY
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