Provider Demographics
NPI:1366515033
Name:ELKUS, MARK ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:ELKUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SOUTH 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213
Mailing Address - Country:US
Mailing Address - Phone:205-939-0610
Mailing Address - Fax:205-930-9134
Practice Address - Street 1:1400 SOUTH 19TH STREET
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213
Practice Address - Country:US
Practice Address - Phone:205-939-0610
Practice Address - Fax:205-930-9134
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024049207XS0114X, 207X00000X, 207XX0801X
AL24049207X00000X, 207XS0114X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
51553670OtherBLUE CROSS-BLUE SHIELD
ALEL009926035Medicaid
AL51553670OtherBLUE CROSS- BLUE SHIELD
ALH84359Medicare UPIN
ALJ361051553670ELKMedicare PIN
51553670OtherBLUE CROSS-BLUE SHIELD
AL051553670ELKMedicare ID - Type Unspecified