Basic Information
| Provider Information | |||||||||
| NPI: | 1841422094 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KFOURY | ||||||||
| FirstName: | ELIAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 20970 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820037020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3079964777 | ||||||||
| FaxNumber: | 3077784995 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 HOUSE AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076371600 | ||||||||
| FaxNumber: | 3076371699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0101256665 | VA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 10758A | WY | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | 10758A | WY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.