Provider Demographics
NPI:1275524951
Name:ELZINGA, DARRYL J (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:J
Last Name:ELZINGA
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 1:4880 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3721
Mailing Address - Country:US
Mailing Address - Phone:616-954-9300
Mailing Address - Fax:616-954-9543
Practice Address - Street 1:4880 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3721
Practice Address - Country:US
Practice Address - Phone:616-954-9300
Practice Address - Fax:616-954-9543
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051146207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2845121Medicaid
MIF29962Medicare UPIN