Provider Demographics
NPI:1497048649
Name:VINCENT R. ELIE MD, PLC
Entity Type:Organization
Organization Name:VINCENT R. ELIE MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-417-7054
Mailing Address - Street 1:105 1/2 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1265
Mailing Address - Country:US
Mailing Address - Phone:734-417-7054
Mailing Address - Fax:734-433-1548
Practice Address - Street 1:105 1/2 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1265
Practice Address - Country:US
Practice Address - Phone:734-417-7054
Practice Address - Fax:734-433-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVE 057786207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4284888Medicaid
1740213115OtherNPI TYPE 1
MIVE057786OtherLICENSE
ON 260970OtherMEDICARE ID NUMBER
MI108123621OtherBCBS
F98022Medicare UPIN