Provider Demographics
NPI:1487678322
Name:HUSARSKY, ELIOT J (MD)
Entity Type:Individual
Prefix:
First Name:ELIOT
Middle Name:J
Last Name:HUSARSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:22301 FOSTER WINTER DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3707
Mailing Address - Country:US
Mailing Address - Phone:248-552-0620
Mailing Address - Fax:248-552-8602
Practice Address - Street 1:22301 FOSTER WINTER DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3707
Practice Address - Country:US
Practice Address - Phone:248-552-0620
Practice Address - Fax:248-552-8602
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT045727207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT045727OtherMEDICAL LICENSE
MI0F39573OtherBLUE CROSS
MIMI4570Medicare PIN