Provider Demographics
NPI:1346212214
Name:ERNSTOFF, RAINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:RAINA
Middle Name:M
Last Name:ERNSTOFF
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3535 W 13 MILE RD
Mailing Address - Street 2:SUITE 747
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6710
Mailing Address - Country:US
Mailing Address - Phone:248-435-5700
Mailing Address - Fax:248-435-3128
Practice Address - Street 1:3535 W 13 MILE RD
Practice Address - Street 2:SUITE 747
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-435-5700
Practice Address - Fax:248-435-3128
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010303162084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346212214Medicaid
MI700H273300OtherBLUE SHIELD OF MICHIGAN
D9143BMedicare UPIN
MI1346212214Medicaid