Provider Demographics
NPI:1952372765
Name:KAILATH, ELIZABETH J (MD,MPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:KAILATH
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 MERCY CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3167
Mailing Address - Country:US
Mailing Address - Phone:916-536-1136
Mailing Address - Fax:916-536-1148
Practice Address - Street 1:6614 MERCY CT
Practice Address - Street 2:SUITE A
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3167
Practice Address - Country:US
Practice Address - Phone:916-536-1136
Practice Address - Fax:916-536-1148
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41552207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A415521Medicare ID - Type Unspecified
CAA88572Medicare UPIN