Provider Demographics
NPI:1538164637
Name:TAWIL, ELIAS A (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:A
Last Name:TAWIL
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 1:2312 S TUCKER TER
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6566
Mailing Address - Country:US
Mailing Address - Phone:620-231-1300
Mailing Address - Fax:620-231-8174
Practice Address - Street 1:2312 S TUCKER TER
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6566
Practice Address - Country:US
Practice Address - Phone:620-231-1300
Practice Address - Fax:620-231-8174
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2023-07-12
Deactivation Date:2023-02-28
Deactivation Code:
Reactivation Date:2023-07-11
Provider Licenses
StateLicense IDTaxonomies
KS04-20368208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS340013264OtherRR MEDICARE
KS110811OtherBLUE CROSS BLUE SHIELD
KS100199740DMedicaid
KS110811OtherBLUE CROSS BLUE SHIELD
KS100199740DMedicaid