Healthcare Provider Details

I. General information

NPI: 1265464549
Provider Name (Legal Business Name): ELIZABETH L. CHMELIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH LYNN CHMELIK

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S STAPLES ST STE 150
CORPUS CHRISTI TX
78404-3173
US

IV. Provider business mailing address

1660 S STAPLES ST STE 150
CORPUS CHRISTI TX
78404-3173
US

V. Phone/Fax

Practice location:
  • Phone: 361-800-8155
  • Fax: 361-882-2590
Mailing address:
  • Phone: 361-800-8155
  • Fax: 361-882-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberM7113
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM7113
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: