Provider Demographics
NPI:1922749100
Name:ROSE, ELYSHA KOLITZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ELYSHA
Middle Name:KOLITZ
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELYSHA
Other - Middle Name:MEGAN
Other - Last Name:KOLITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12001 INWOOD RD APT 1302
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-4003
Mailing Address - Country:US
Mailing Address - Phone:972-841-7118
Mailing Address - Fax:
Practice Address - Street 1:8200 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4402
Practice Address - Country:US
Practice Address - Phone:214-345-6176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program