Provider Demographics
NPI:1033176599
Name:RZEPKAALTO, ELIZABETH WHITNEY (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WHITNEY
Last Name:RZEPKAALTO
Suffix:
Gender:F
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 963
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0963
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:7917 MACKINAW TRL
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-9746
Practice Address - Country:US
Practice Address - Phone:231-779-9700
Practice Address - Fax:231-779-9765
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079950208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
M37180006Medicare ID - Type Unspecified
I35663Medicare UPIN