1255704805 NPI number — ELIZABETH A PENSLER DO PLLC

Table of content: (NPI 1255704805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255704805 NPI number — ELIZABETH A PENSLER DO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIZABETH A PENSLER DO PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PENSLER VEIN AND VASCULAR SUGICAL INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255704805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71587
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON HEIGHTS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48071-0587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-751-3480
Provider Business Mailing Address Fax Number:
888-850-3877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
928 E 10 MILE RD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERNDALE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48220-3041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-268-4296
Provider Business Practice Location Address Fax Number:
888-850-3877
Provider Enumeration Date:
11/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PENSLER
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR/OWNER
Authorized Official Telephone Number:
586-751-3480

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  5101017420 , 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)





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