Provider Demographics
NPI:1639412026
Name:KAO, ELAINE K (MD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:K
Last Name:KAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14231 SEAWAY RD STE 3004
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4653
Mailing Address - Country:US
Mailing Address - Phone:228-206-1905
Mailing Address - Fax:
Practice Address - Street 1:2121 RIDGELAKE DR FL 3
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2080
Practice Address - Country:US
Practice Address - Phone:504-325-2700
Practice Address - Fax:504-455-0097
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25231207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty