Provider Demographics
NPI:1366646143
Name:KIM, ELIZABETH CARROLL (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CARROLL
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:CARROLL
Other - Last Name:PITTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6513 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2688
Mailing Address - Country:US
Mailing Address - Phone:972-608-2025
Mailing Address - Fax:
Practice Address - Street 1:6513 PRESTON RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2688
Practice Address - Country:US
Practice Address - Phone:972-608-2025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5157208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN5157OtherTEXAS MEDICAL BOARD
BP1-0022849OtherINSTITUTIONAL PERMIT