Provider Demographics
NPI:1689029159
Name:ELZINGA, KATE E (MD)
Entity type:Individual
Prefix:DR
First Name:KATE
Middle Name:E
Last Name:ELZINGA
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 1:820 SHERBROOK STREET
Mailing Address - Street 2:GC404, HEALTH SCIENCES CENTER
Mailing Address - City:MANITOBA
Mailing Address - State:WINNIPEG
Mailing Address - Zip Code:R3A1R9
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 SHERBROOK STREET
Practice Address - Street 2:GC404, HEALTH SCIENCES CENTER
Practice Address - City:MANITOBA
Practice Address - State:WINNIPEG
Practice Address - Zip Code:R3A1R9
Practice Address - Country:CA
Practice Address - Phone:204-787-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301109158390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program