Provider Demographics
NPI:1073669511
Name:MIKE, ELLIOTT P (PMT)
Entity Type:Individual
Prefix:MR
First Name:ELLIOTT
Middle Name:P
Last Name:MIKE
Suffix:
Gender:M
Credentials:PMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMDT CG-1122 US COAST GUARD
Mailing Address - Street 2:2100 2ND ST SW, SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:510-437-6641
Mailing Address - Fax:510-437-3943
Practice Address - Street 1:1 EAGLE RD
Practice Address - Street 2:CG ISLAND
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5100
Practice Address - Country:US
Practice Address - Phone:510-437-6641
Practice Address - Fax:510-437-3943
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other