Healthcare Provider Details

I. General information

NPI: 1689029159
Provider Name (Legal Business Name): KATE E ELZINGA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 SHERBROOK STREET GC404, HEALTH SCIENCES CENTER
MANITOBA WINNIPEG
R3A1R9
CA

IV. Provider business mailing address

820 SHERBROOK STREET GC404, HEALTH SCIENCES CENTER
MANITOBA WINNIPEG
R3A1R9
CA

V. Phone/Fax

Practice location:
  • Phone: 204-787-1485
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: