Provider Demographics
NPI:1770770240
Name:EZRA S ELKAYAM MD PA
Entity type:Organization
Organization Name:EZRA S ELKAYAM MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EZRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ELKAYAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-793-0663
Mailing Address - Street 1:1840 MEASE DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6602
Mailing Address - Country:US
Mailing Address - Phone:727-793-0663
Mailing Address - Fax:727-793-0664
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 315
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-793-0663
Practice Address - Fax:727-793-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269879000Medicaid
Y27166Medicare UPIN
FL269879000Medicaid