Individual
DR. ELIJAH MICHAEL POULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1003 WILLOW CREEK RD, PRESCOTT, AZ 86301-1641
(928) 773-0003
(928) 773-1170
Mailing address
PO BOX 967, FLAGSTAFF, AZ 86002-0967
(928) 773-0003
(928) 773-1170
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R71506
AZ
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
46193
AZ
207RP1001X
Pulmonary Disease Physician
46193
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026439
—
AZ
Enumeration date
06/17/2009
Last updated
08/20/2024
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