Provider Demographics
NPI:1881190379
Name:KAVENSKY, ELISSE ARIEL (MD)
Entity type:Individual
Prefix:
First Name:ELISSE
Middle Name:ARIEL
Last Name:KAVENSKY
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 1:601 N CONGRESS AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4639
Mailing Address - Country:US
Mailing Address - Phone:561-272-1618
Mailing Address - Fax:
Practice Address - Street 1:601 N CONGRESS AVE STE 403
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4639
Practice Address - Country:US
Practice Address - Phone:561-272-1618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine