Provider Demographics
NPI:1104856897
Name:GILLETT-ELRINGTON, ANN R (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:R
Last Name:GILLETT-ELRINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:R
Other - Last Name:ELRINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3516 IRENE ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-2127
Mailing Address - Country:US
Mailing Address - Phone:313-421-6794
Mailing Address - Fax:
Practice Address - Street 1:2700 HAMLIN BLVD
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-2206
Practice Address - Country:US
Practice Address - Phone:313-561-5100
Practice Address - Fax:313-565-0309
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010727472083A0300X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAG072747OtherBCBS OF MICHIGAN
MI4441747Medicaid
MI4441747Medicaid
MIH81482Medicare UPIN