Provider Demographics
NPI:1760617518
Name:ELZINGA, REBECCA ROSE (DPM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ROSE
Last Name:ELZINGA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ROSE
Other - Last Name:HAUGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4774 GRANDWOODS DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1330
Mailing Address - Country:US
Mailing Address - Phone:517-721-1298
Mailing Address - Fax:517-721-1829
Practice Address - Street 1:4774 GRANDWOODS DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-1330
Practice Address - Country:US
Practice Address - Phone:517-721-1298
Practice Address - Fax:517-721-1829
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006287213E00000X
AZ390200000X
MI5901002467213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program