Provider Demographics
NPI:1982261525
Name:ELJAZZAR, RACHELLE (MD)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:ELJAZZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:4825 OLSON MEMORIAL HWY STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55422-5141
Practice Address - Country:US
Practice Address - Phone:763-545-0443
Practice Address - Fax:763-545-2784
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN764372086S0122X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery