Provider Demographics
NPI:1417243445
Name:ELLIOTT, MICHAEL ROBINSON (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBINSON
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:DEPT OF DERMATOLOGY
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-7546
Mailing Address - Fax:319-356-0349
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPT OF DERMATOLOGY
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-7546
Practice Address - Fax:319-356-0349
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant