Individual
MAZIN ELLIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4131 W LOOMIS RD, STE 300, GREENFIELD, WI 53221-2057
(414) 325-7246
(414) 325-3770
Mailing address
4131 W LOOMIS RD, STE 300, GREENFIELD, WI 53221-2057
(414) 325-7246
(414) 325-3770
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
40486020
WI
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
40486-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002339110
MEDICARE - HUMANA GOLD
WI
01
—
32492200
MANAGED HEALTH CARE
WI
05
—
32492200
—
WI
01
—
391330887
ASSOCIATES FOR HEALTHCARE
WI
01
—
68959
SECURITY HEALTH PLAN
WI
01
—
ELLIAS
WPS
WI
01
—
P00267689
MEDICARE RAILROAD
WI
Enumeration date
07/17/2006
Last updated
02/03/2014
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