Provider Demographics
NPI:1629364138
Name:ZABAK, ELAINA M (MD)
Entity Type:Individual
Prefix:
First Name:ELAINA
Middle Name:M
Last Name:ZABAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:M
Other - Last Name:MATOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14679 MIDWAY RD STE 206
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3197
Mailing Address - Country:US
Mailing Address - Phone:469-317-9900
Mailing Address - Fax:
Practice Address - Street 1:14679 MIDWAY RD STE 206
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3197
Practice Address - Country:US
Practice Address - Phone:469-317-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP65592085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology