Provider Demographics
NPI:1003927773
Name:ELJAIEK, FELIPE (MD)
Entity Type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:
Last Name:ELJAIEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PROGRESS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:MO
Mailing Address - Zip Code:63080
Mailing Address - Country:US
Mailing Address - Phone:573-468-3554
Mailing Address - Fax:573-468-3554
Practice Address - Street 1:101 PROGRESS PKWY
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:MO
Practice Address - Zip Code:63080-2359
Practice Address - Country:US
Practice Address - Phone:573-468-3555
Practice Address - Fax:573-468-3554
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102270207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00430677OtherRAILROAD MEDICARE
MO206677106Medicaid
F57509Medicare UPIN
MO206677106Medicaid
P00430677OtherRAILROAD MEDICARE