1720195605 NPI number — DR. ELHAM H ELZIND M.D.

Table of content: DR. ELHAM H ELZIND M.D. (NPI 1720195605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720195605 NPI number — DR. ELHAM H ELZIND M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELZIND
Provider First Name:
ELHAM
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720195605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98978
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89193-8978
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-216-3346
Provider Business Mailing Address Fax Number:
702-671-6883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9260 W SUNSET RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-4903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-216-3346
Provider Business Practice Location Address Fax Number:
702-671-6883
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  19502 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: ME0075058 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2198250 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 254318400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42756 . This is a "BLUECROSS/ BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60077 . This is a "PARITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 026876 . This is a "NEIGHBORHOOD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 244626 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5358650 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6503052028 . This is a "BEACON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223712 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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