Provider Demographics
NPI:1023028008
Name:GALLA-ELIZEUS, KATHY LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNNE
Last Name:GALLA-ELIZEUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2480
Mailing Address - Country:US
Mailing Address - Phone:419-660-2980
Mailing Address - Fax:419-660-2985
Practice Address - Street 1:38 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857
Practice Address - Country:US
Practice Address - Phone:419-660-2980
Practice Address - Fax:419-660-2985
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063871L207V00000X
OH35.135465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0338195Medicaid
PA0017522330008Medicaid
027872Medicare ID - Type Unspecified