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General NPI Number Information
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NPI Number | 1588107957
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Entity Type | Organization
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Legal Business Name | ELIAS CARDIOVASCULAR DISEASE PLLC
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 12/02/2016
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Provider Practice Location Address
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Address Line | 1104 E STATE HIGHWAY 152 UNIT 2
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City | MUSTANG
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State | OK
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Zip | 73064-5116
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Country | US
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Telephone | 855-541-2862
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Fax | 405-716-4808
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Provider Business Mailing Address
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Address Line | 1104 E STATE HIGHWAY 152 UNIT 2
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City | MUSTANG
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State | OK
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Zip | 73064-5116
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Country | US
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Telephone | 855-541-2862
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Fax | 405-716-4808
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Authorized Official
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Title or Position | CEO
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Name | ELIAS SOLOMON
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Credential | M.D
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Telephone | 855-541-2862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 24555
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License Number State | OK
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