Provider Demographics
NPI:1306863253
Name:NTAKIRUTIMANA, ELIEL (M D)
Entity Type:Individual
Prefix:DR
First Name:ELIEL
Middle Name:
Last Name:NTAKIRUTIMANA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:ELIEL
Other - Middle Name:
Other - Last Name:NATAKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6801 MCPHERSON RD STE 334
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6417
Mailing Address - Country:US
Mailing Address - Phone:956-727-7246
Mailing Address - Fax:956-728-8827
Practice Address - Street 1:6801 MCPHERSON RD STE 334
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6417
Practice Address - Country:US
Practice Address - Phone:956-727-7246
Practice Address - Fax:956-728-8827
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1013207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130417207Medicaid
E14874Medicare UPIN
TX88515HMedicare ID - Type Unspecified
TX130417207Medicaid