Provider Demographics
NPI:1922043421
Name:CHALHUB, ELIAS G (MD)
Entity type:Individual
Prefix:
First Name:ELIAS
Middle Name:G
Last Name:CHALHUB
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5108
Mailing Address - Fax:251-660-5792
Practice Address - Street 1:1601 CENTER STREET
Practice Address - Street 2:STE 2S
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1512
Practice Address - Country:US
Practice Address - Phone:251-660-5108
Practice Address - Fax:251-660-5792
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00008386174400000X
AL83862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-22856OtherBLUE CROSS PROVIDER#
AL000022856Medicaid
ALC74412Medicare UPIN
AL000022856Medicaid
ALD985Medicare PIN