Provider Demographics
NPI:1710932017
Name:HIMMELFARB, ELLIOT H (MD)
Entity Type:Individual
Prefix:MR
First Name:ELLIOT
Middle Name:H
Last Name:HIMMELFARB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD81912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1509269OtherMEDICAID - MTI
TN4068857OtherBCBS
TN4200724OtherBCBS TN
KY64071590OtherKY MEDICAID
TN1509269Medicaid
TN4068499OtherBCBS
TNPENDINGOtherRAILROAD MEDICARE
TN4291392OtherBCBS - MTI
TN3161070Medicaid
TN3161076Medicare PIN
TN4068857OtherBCBS
TN3161075Medicare PIN
TN1509269Medicaid
TN31610751Medicare PIN