Provider Demographics
NPI:1568599207
Name:HORN, ELSA BOAYES (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:BOAYES
Last Name:HORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELSA
Other - Middle Name:B
Other - Last Name:DOROIN-HORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:22 RIDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-7623
Mailing Address - Country:US
Mailing Address - Phone:920-921-3324
Mailing Address - Fax:
Practice Address - Street 1:W9071 FOREST DRIVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-0031
Practice Address - Country:US
Practice Address - Phone:920-526-3044
Practice Address - Fax:920-526-3819
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist