# ELISSA B GARTENBERG

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1639152291
- **Gender:** F
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 4155 | AZ | Yes |
| 207Q00000X | Family Medicine Physician | 5101015264 | MI | — |

## Other

- **Enumeration date:** 11/28/2005
- **Last updated:** 05/12/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 240988 | — | AZ |
| 01 | — | Z154007 | MEDICARE PTAN | AZ |