Provider Demographics
NPI:1598753865
Name:WACK, ELIZABETH E (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:E
Last Name:WACK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2001 W. ORANGE GROVE RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704
Mailing Address - Country:US
Mailing Address - Phone:520-989-0226
Mailing Address - Fax:520-989-3798
Practice Address - Street 1:2001 W. ORANGE GROVE RD
Practice Address - Street 2:SUITE 404
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-989-0226
Practice Address - Fax:520-989-3798
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2017-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ14736207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ266446Medicaid
AZD00519Medicare UPIN