Provider Demographics
NPI:1467744763
Name:ALCANTARA, ELSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:
Last Name:ALCANTARA
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 1:53 BRIARCLIFF PL
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1104
Mailing Address - Country:US
Mailing Address - Phone:313-882-2813
Mailing Address - Fax:313-882-2813
Practice Address - Street 1:53 BRIARCLIFF PL
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE SHORES
Practice Address - State:MI
Practice Address - Zip Code:48236-1104
Practice Address - Country:US
Practice Address - Phone:313-882-2813
Practice Address - Fax:313-882-2813
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030631207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301030631OtherMEDICAL LICENSE