Provider Demographics
NPI:1003803966
Name:GREENSPAN, ELLIOTT I (DO)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:I
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6962 SPRUCE HILL CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3704
Mailing Address - Country:US
Mailing Address - Phone:248-245-4833
Mailing Address - Fax:248-737-0159
Practice Address - Street 1:6962 SPRUCE HILL CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3704
Practice Address - Country:US
Practice Address - Phone:248-245-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1188028-11Medicaid
MI3142396-11Medicaid
MI1791545-11Medicaid
MI4865778-11Medicaid
MI1188028-11Medicaid
MIOH26262 003Medicare ID - Type Unspecified