Basic Information
| Provider Information | |||||||||
| NPI: | 1598808180 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELKAYAM | ||||||||
| FirstName: | LIOR | ||||||||
| MiddleName: | URIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 S STATE ROAD 7 STE 249 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330236718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547435522 | ||||||||
| FaxNumber: | 9547435632 | ||||||||
| Practice Location | |||||||||
| Address1: | 390 S STATE ROAD 7 STE 249 | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330236718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547435522 | ||||||||
| FaxNumber: | 9547435632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 11/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 236526 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | ME103075 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 9361592 | 01 | FL | AETNA | OTHER | 002257600 | 05 | FL | MEDICAID |