Provider Demographics
NPI:1235332917
Name:SKAF, ELIAS (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:SKAF
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 1:1222 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3406
Mailing Address - Country:US
Mailing Address - Phone:810-985-9681
Mailing Address - Fax:810-985-5310
Practice Address - Street 1:1222 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3406
Practice Address - Country:US
Practice Address - Phone:810-985-9681
Practice Address - Fax:810-985-5310
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083143207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG46015013Medicare PIN