Provider Demographics
NPI:1205031226
Name:ELKABANI, SAMIR A (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:A
Last Name:ELKABANI
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 1:1355 N COURTENAY PKWY
Mailing Address - Street 2:I
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4401
Mailing Address - Country:US
Mailing Address - Phone:321-459-5311
Mailing Address - Fax:321-459-5367
Practice Address - Street 1:1355 N COURTENAY PKWY
Practice Address - Street 2:I
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4401
Practice Address - Country:US
Practice Address - Phone:321-459-5311
Practice Address - Fax:321-459-5367
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19630207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05311AMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER