MEDICARE: ELIE GEORGE ELIAS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	36.003810	OH

General Provider Information

NPI Number	:	1174938872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIE GEORGE ELIAS DPM

Provider Business Mailing Address
First Line	:	850 BRAINARD RD
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3146
Country	:	US
Telephone Number	:	440-473-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 BRAINARD RD
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	OH
Zip	:	44143-3146
Country	:	US
Telephone Number	:	440-473-0550
Fax Number	:

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	03/17/2018

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