Individual
EDDY ELKASSIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
995 E BASELINE RD APT 2116, TEMPE, AZ 85283-1363
(810) 813-5550
Mailing address
6036 JENNIFER CRES, WEST BLOOMFIELD, MI 48324-3127
(810) 813-5550
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704369610
MI
363L00000X
Nurse Practitioner
Primary
305068
AZ
Other
Enumeration date
01/19/2022
Last updated
11/02/2024
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