MEDICARE: JEMAL ELEMO

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1255024204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEMAL ELEMO

Provider Business Mailing Address
First Line	:	5722 N BLACK CANYON HWY APT 26
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-2113
Country	:	US
Telephone Number	:	480-252-5859
Fax Number	:

Provider Business Practice Location Address
First Line	:	5722 N BLACK CANYON HWY APT 26
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85017-2113
Country	:	US
Telephone Number	:	480-252-5859
Fax Number	:

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

Provider Enumeration Date	:	05/26/2023
Last Update Date	:	05/26/2023

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Directions to “ JEMAL ELEMO ” Practice Location

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