Provider Demographics
NPI:1407837057
Name:PLYLER, ELSIE DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSIE
Middle Name:DIANE
Last Name:PLYLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BALLENGER HWY
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-3638
Mailing Address - Country:US
Mailing Address - Phone:810-342-1000
Mailing Address - Fax:810-342-1590
Practice Address - Street 1:2316 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3152
Practice Address - Country:US
Practice Address - Phone:517-702-4130
Practice Address - Fax:517-702-4139
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0100174OtherPHYSICIANS HEALTH PLAN
MI4062824OtherAETNA
MI4509093Medicaid
MI4439453Medicaid
MI201486OtherMCLAREN HEALTH ADVANTAGE
MI201486OtherHEALTH ADVANTAGE NETWORK
MIE49554OtherHEALTH NET FED SERVICES
MI4758123Medicaid
MI201486OtherHEALTH ADVANTAGE NETWORK
MI0100174OtherPHYSICIANS HEALTH PLAN