Provider Demographics
NPI:1083200349
Name:NABILA ELZIND MD PC
Entity type:Organization
Organization Name:NABILA ELZIND MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAGWA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINAISY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-506-7458
Mailing Address - Street 1:4411 W GORE BLVD STE B4
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5977
Mailing Address - Country:US
Mailing Address - Phone:580-351-2400
Mailing Address - Fax:580-351-2414
Practice Address - Street 1:4411 W GORE BLVD STE B4
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5977
Practice Address - Country:US
Practice Address - Phone:580-351-2400
Practice Address - Fax:580-351-2414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100017810BMedicaid