Provider Demographics
NPI:1609570274
Name:KOUTLEVA, ELITZA (MD, MBA)
Entity Type:Individual
Prefix:
First Name:ELITZA
Middle Name:
Last Name:KOUTLEVA
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANNING DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7512
Mailing Address - Country:US
Mailing Address - Phone:984-974-8415
Mailing Address - Fax:984-974-8607
Practice Address - Street 1:101 MANNING DRIVE
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7512
Practice Address - Country:US
Practice Address - Phone:984-974-8415
Practice Address - Fax:984-974-8607
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program