Provider Demographics
NPI:1730150582
Name:ADDIS, ELANA B (MD)
Entity type:Individual
Prefix:
First Name:ELANA
Middle Name:B
Last Name:ADDIS
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 1:575 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5822
Mailing Address - Country:US
Mailing Address - Phone:520-874-3500
Mailing Address - Fax:520-874-3484
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-0001
Practice Address - Country:US
Practice Address - Phone:520-874-3500
Practice Address - Fax:520-874-3484
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ33109207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ887979Medicaid
H60319Medicare UPIN
AZ887979Medicaid