Healthcare Provider Details

I. General information

NPI: 1083969893
Provider Name (Legal Business Name): DILEK ELBISTAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DILEK YARAR M.D.

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHESTNUT ST
BOWLING GREEN KY
42101-1738
US

IV. Provider business mailing address

500 CHESTNUT ST
BOWLING GREEN KY
42101-1738
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-2050
  • Fax: 270-737-9252
Mailing address:
  • Phone: 270-904-2050
  • Fax: 270-737-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125061951
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51150
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number51150
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: