Healthcare Provider Details

I. General information

NPI: 1134104250
Provider Name (Legal Business Name): ELSIE VERBIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2005
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 3RD ST
LAKE VIEW IA
51450-7474
US

IV. Provider business mailing address

1160 3RD ST
LAKE VIEW IA
51450-7474
US

V. Phone/Fax

Practice location:
  • Phone: 712-657-8555
  • Fax: 712-657-2002
Mailing address:
  • Phone: 712-657-8555
  • Fax: 712-657-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30943
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: