Provider Demographics
NPI:1730455189
Name:ELOBAID, SUHAIB KAMAL (MD)
Entity type:Individual
Prefix:
First Name:SUHAIB
Middle Name:KAMAL
Last Name:ELOBAID
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 1:4945 S HERITAGE DR
Mailing Address - Street 2:W202
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-5399
Mailing Address - Country:US
Mailing Address - Phone:919-949-2654
Mailing Address - Fax:
Practice Address - Street 1:4945 S HERITAGE DR
Practice Address - Street 2:W202
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-5399
Practice Address - Country:US
Practice Address - Phone:919-949-2654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI61968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program