Provider Demographics
NPI:1821130600
Name:PAYNE, ELIZABETH E (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:E
Last Name:PAYNE
Suffix:
Gender:F
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:PO BOX 2531
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311
Mailing Address - Country:US
Mailing Address - Phone:763-494-9882
Mailing Address - Fax:763-494-9883
Practice Address - Street 1:122 HWY 55 NE
Practice Address - Street 2:#620
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313
Practice Address - Country:US
Practice Address - Phone:763-494-9882
Practice Address - Fax:763-494-9883
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18878207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D8133604Medicare UPIN
040000111Medicare ID - Type Unspecified