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NPI Code Detail

MEDICARE: ROBERT ELK M.D.

MEDICARE: ROBERT ELK 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
1207R00000XInternal Medicine Physician13116AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083643514
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT ELK M.D.
Provider Business Mailing Address
First Line : 9520 W PALM LN
Second Line : SUITE 200
City : PHOENIX
State : AZ
Zip : 85037-4403
Country : US
Telephone Number : 623-583-3001
Fax Number : 623-583-3007
Provider Business Practice Location Address
First Line : 1705 W MAIN ST
Second Line :
City : MESA
State : AZ
Zip : 85201-6920
Country : US
Telephone Number : 877-809-5092
Fax Number : 480-491-6239
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 04/11/2013

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