Provider Demographics
NPI:1073780292
Name:JDANOVA, ELENA N (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:N
Last Name:JDANOVA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4967 CROOKS RD
Mailing Address - Street 2:STE. 130
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5801
Mailing Address - Country:US
Mailing Address - Phone:248-952-1601
Mailing Address - Fax:248-952-1614
Practice Address - Street 1:26677 W 12 MILE RD # B6
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1514
Practice Address - Country:US
Practice Address - Phone:248-354-4709
Practice Address - Fax:248-354-4807
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2022-09-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIEJ089660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1073780292Medicaid
MIEJ089660OtherLICENSE
MI1346398971OtherGRP NPI
MIEJ089660OtherLICENSE