MEDICARE: DR. FELIPE ELJAIEK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	102270	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00430677	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003927773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FELIPE ELJAIEK M.D.

Provider Business Mailing Address
First Line	:	101 PROGRESS PARKWAY
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080
Country	:	US
Telephone Number	:	573-468-3554
Fax Number	:	573-468-3554

Provider Business Practice Location Address
First Line	:	101 PROGRESS PKWY
Second Line	:
City	:	SULLIVAN
State	:	MO
Zip	:	63080-2359
Country	:	US
Telephone Number	:	573-468-3555
Fax Number	:	573-468-3554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/26/2012

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