Provider Demographics
NPI:1598716094
Name:ELLINAS, ELIZABETH HOLLENBACK (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HOLLENBACK
Last Name:ELLINAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:HOLLENBACK-ELLINAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5000 W CHAMBERS ST
Mailing Address - Street 2:HOSPITAL BASED @ ST. JOSEPH HOSP.
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1650
Mailing Address - Country:US
Mailing Address - Phone:414-447-2967
Mailing Address - Fax:414-447-2883
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-805-3666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41825207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
006000215HOtherHUMANA
WI32614200Medicaid
WI1598716094Medicaid
G88264Medicare UPIN