Provider Demographics
NPI:1073775110
Name:ELMESALLATI, HUSAMEDDIN M (MD)
Entity type:Individual
Prefix:
First Name:HUSAMEDDIN
Middle Name:M
Last Name:ELMESALLATI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50224
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89016-0224
Mailing Address - Country:US
Mailing Address - Phone:702-256-3637
Mailing Address - Fax:
Practice Address - Street 1:3022 S DURANGO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-4440
Practice Address - Country:US
Practice Address - Phone:702-256-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073775110Medicaid