Provider Demographics
NPI:1063126332
Name:ELMI, LIBAN ABDUKADIR
Entity type:Individual
Prefix:
First Name:LIBAN
Middle Name:ABDUKADIR
Last Name:ELMI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 MORSE RD STE 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6175
Mailing Address - Country:US
Mailing Address - Phone:614-806-2032
Mailing Address - Fax:
Practice Address - Street 1:4179 HELENROSE LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-4059
Practice Address - Country:US
Practice Address - Phone:614-806-2032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver