Provider Demographics
NPI:1972661544
Name:LOUIE, ELIZABETH MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARIE
Last Name:LOUIE
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 1:181 MILL ST
Mailing Address - Street 2:
Mailing Address - City:LYNNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38472-3138
Mailing Address - Country:US
Mailing Address - Phone:954-340-6888
Mailing Address - Fax:561-368-8687
Practice Address - Street 1:181 MILL ST
Practice Address - Street 2:
Practice Address - City:LYNNVILLE
Practice Address - State:TN
Practice Address - Zip Code:38472-3138
Practice Address - Country:US
Practice Address - Phone:931-347-4971
Practice Address - Fax:931-347-4978
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373825600Medicaid
FLK6616OtherGROUP ID
FLF72158Medicare UPIN
FLK6616OtherGROUP ID