Basic Information
| Provider Information | |||||||||
| NPI: | 1770500431 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ELLIAS | ||||||||
| FirstName: | MAZIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4131 W LOOMIS RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143257246 | ||||||||
| FaxNumber: | 4143253770 | ||||||||
| Practice Location | |||||||||
| Address1: | 4131 W LOOMIS RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GREENFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143257246 | ||||||||
| FaxNumber: | 4143253770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 40486020 | WI | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 40486-020 | WI | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 391330887 | 01 | WI | ASSOCIATES FOR HEALTHCARE | OTHER | 391330887 | 01 | WI | HEALTH EOS | OTHER | 32492200 | 01 | WI | MANAGED HEALTH CARE | OTHER | P00267689 | 01 | WI | MEDICARE RAILROAD | OTHER | 68959 | 01 | WI | SECURITY HEALTH PLAN | OTHER | 32492200 | 05 | WI | MEDICAID | 68959 | 01 | WI | SECURITY HEALTH MEDICAID | OTHER | 002339110 | 01 | WI | MEDICARE - HUMANA GOLD | OTHER | ELLIAS | 01 | WI | WPS | OTHER |