Provider Demographics
NPI:1295826840
Name:LODEJ, ELZBIETA
Entity Type:Individual
Prefix:
First Name:ELZBIETA
Middle Name:
Last Name:LODEJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16802 SALERNO CT
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4801
Mailing Address - Country:US
Mailing Address - Phone:810-286-2608
Mailing Address - Fax:
Practice Address - Street 1:15918 19 MILE RD STE 150
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1101
Practice Address - Country:US
Practice Address - Phone:586-228-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN/AOtherPTA