Provider Demographics
NPI:1780047332
Name:VERHEYEN, ELIJAH
Entity type:Individual
Prefix:
First Name:ELIJAH
Middle Name:
Last Name:VERHEYEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TAMAL PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1196
Mailing Address - Country:US
Mailing Address - Phone:415-925-6900
Mailing Address - Fax:415-925-6919
Practice Address - Street 1:200 TAMAL PLZ STE 200
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1196
Practice Address - Country:US
Practice Address - Phone:415-925-6900
Practice Address - Fax:415-925-6919
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA177770207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology