1780630905 NPI number — DR. ROBIN L ELKUS M.D.

Table of content: DR. ROBIN L ELKUS M.D. (NPI 1780630905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780630905 NPI number — DR. ROBIN L ELKUS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELKUS
Provider First Name:
ROBIN
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1780630905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44555 WOODWARD AVE STE 504
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PONTIAC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48341-5039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-858-9624
Provider Business Mailing Address Fax Number:
248-858-9625

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44555 WOODWARD AVE
Provider Second Line Business Practice Location Address:
STE 504
Provider Business Practice Location Address City Name:
PONTIAC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-858-9624
Provider Business Practice Location Address Fax Number:
248-858-9625
Provider Enumeration Date:
05/26/2006

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: 207RP1001X , with the licence number:  430155958 , 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: 700H273300 . This is a "BCBSM GROUP PIN MHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4262998 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: DS0605 . This is a "RAIL ROAD MEDICARE GROUP PIN MHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MI4989 . This is a "MEDICARE GROUP PIN MHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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