Provider Demographics
NPI:1407902919
Name:SUNDBERG, ELIZABETH ELAINE (MD PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELAINE
Last Name:SUNDBERG
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EAST ST. N
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:ND
Mailing Address - Zip Code:58533
Mailing Address - Country:US
Mailing Address - Phone:701-584-2792
Mailing Address - Fax:
Practice Address - Street 1:601 EAST ST. N
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:ND
Practice Address - Zip Code:58533
Practice Address - Country:US
Practice Address - Phone:701-584-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9008207P00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA28837OtherSTATE LICENSE
ND9008OtherSTATE LICENSE
ND1457964Medicaid