Provider Demographics
NPI:1174066005
Name:ELAJAMI, TAREC KHALED (MD)
Entity type:Individual
Prefix:
First Name:TAREC
Middle Name:KHALED
Last Name:ELAJAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 AVENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3118
Mailing Address - Country:US
Mailing Address - Phone:305-692-1010
Mailing Address - Fax:
Practice Address - Street 1:2845 AVENTURA BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3118
Practice Address - Country:US
Practice Address - Phone:305-692-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-26
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162161207RC0000X
IA49702207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty