MEDICARE: ELSADIG A ELTAHIR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	342000000X	Transportation Network Company		AZ

General Provider Information

NPI Number	:	1124728332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELSADIG A ELTAHIR

Provider Business Mailing Address
First Line	:	3865 E FAIRVIEW ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-2772
Country	:	US
Telephone Number	:	480-383-9443
Fax Number	:

Provider Business Practice Location Address
First Line	:	64 E BROADWAY RD
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-1353
Country	:	US
Telephone Number	:	480-383-9443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	03/06/2023

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Directions to “ ELSADIG A ELTAHIR ” Practice Location

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