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General NPI Number Information
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NPI Number | 1821562026
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Entity Type | Individual
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Provider Name | ZIYAD ABDEL-FATTAH ELEWA LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 2104 NORTHDALE BLVD NW STE 100
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City | COON RAPIDS
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State | MN
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Zip | 55433-3045
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Country | US
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Telephone | 612-418-6077
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Fax |
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Provider Business Mailing Address
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Address Line | 5041 NICOLLET AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55419-2613
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Country | US
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Telephone | 414-403-5298
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 3335
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License Number State | MN
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