Provider Demographics
NPI:1043339138
Name:ATKINSON, M ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:M ELIZABETH
Middle Name:
Last Name:ATKINSON
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 1:1036 FULLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1304
Mailing Address - Country:US
Mailing Address - Phone:616-233-8574
Mailing Address - Fax:
Practice Address - Street 1:1036 FULLER AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1304
Practice Address - Country:US
Practice Address - Phone:616-233-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077211207RH0000X, 207ZB0001X
WI28742020207RH0000X, 207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Not Answered207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31475800Medicaid
D86988Medicare UPIN
74982Medicare ID - Type Unspecified