Provider Demographics
NPI:1265464549
Name:CHMELIK, ELIZABETH L (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:L
Last Name:CHMELIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LYNN
Other - Last Name:CHMELIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1660 S STAPLES ST
Mailing Address - Street 2:STE 150
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3173
Mailing Address - Country:US
Mailing Address - Phone:361-800-8155
Mailing Address - Fax:361-882-2590
Practice Address - Street 1:1660 S STAPLES ST
Practice Address - Street 2:STE 150
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3173
Practice Address - Country:US
Practice Address - Phone:361-800-8155
Practice Address - Fax:361-882-2590
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7113208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB155616OtherWELLMED NETWORKS INC
TXB150355OtherWELLMED MEDICAL GROUP PA
TXB155616OtherWELLMED NETWORKS INC
FL260291100Medicaid
FL51865Medicare ID - Type Unspecified