Provider Demographics
NPI:1760450472
Name:KINZIE, ELIZABETH ROMANIK (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ROMANIK
Last Name:KINZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ROMANIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5300 N INDEPENDENCE AVE STE 280
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5555
Mailing Address - Country:US
Mailing Address - Phone:405-945-4587
Mailing Address - Fax:405-713-2735
Practice Address - Street 1:1084 NICKERSON ST
Practice Address - Street 2:
Practice Address - City:WAYNOKA
Practice Address - State:OK
Practice Address - Zip Code:73860
Practice Address - Country:US
Practice Address - Phone:580-824-2291
Practice Address - Fax:580-824-0429
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25482207R00000X, 2084P0800X
HIMD10362207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA101651Medicare PIN