Provider Demographics
NPI:1619395068
Name:ELISHA, ADAM YANIV (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:YANIV
Last Name:ELISHA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E 1ST ST STE 302
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-249-6960
Mailing Address - Fax:218-249-6969
Practice Address - Street 1:1000 E 1ST ST STE 302
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-249-6960
Practice Address - Fax:218-249-6969
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN65241207R00000X, 207RR0500X
PAOT018163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine