Provider Demographics
NPI:1609879006
Name:GIZAW, ELIAS M (MD)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:M
Last Name:GIZAW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:755 STIRLING CENTER PL
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5714
Mailing Address - Country:US
Mailing Address - Phone:407-333-1718
Mailing Address - Fax:407-333-1633
Practice Address - Street 1:755 STIRLING CENTER PL
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5714
Practice Address - Country:US
Practice Address - Phone:407-333-1718
Practice Address - Fax:407-333-1633
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME67379174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377287000Medicaid
FL377287000Medicaid