1386746725 NPI number — DR. ELISE MURRAY D.O.

Table of content: DR. ELISE MURRAY D.O. (NPI 1386746725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386746725 NPI number — DR. ELISE MURRAY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
ELISE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MURRAY
Provider Other First Name:
ELISE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1386746725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33611 WARREN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48185-2787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-641-8900
Provider Business Mailing Address Fax Number:
734-641-8970

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33611 WARREN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48185-2787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-641-8900
Provider Business Practice Location Address Fax Number:
734-641-8970
Provider Enumeration Date:
09/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  5101011754 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1158202914 . This is a "BCN IND" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: G16535 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1158202914 . This is a "BCBS IND" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1386746725 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110236363 . This is a "RAILROAD MEDICARE IND PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5940073 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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