MEDICARE: SANDRA M ELAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	15112	KY
2	2084P0804X	Child & Adolescent Psychiatry Physician	15112	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154471183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA M ELAM MD

Provider Business Mailing Address
First Line	:	5406 NAVAJO RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-1685
Country	:	US
Telephone Number	:	502-417-0852
Fax Number	:

Provider Business Practice Location Address
First Line	:	4229 BARDSTOWN RD STE 207
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-4200
Country	:	US
Telephone Number	:	502-451-4701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	09/03/2021

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Directions to “ SANDRA M ELAM MD” Practice Location

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