Provider Demographics
NPI:1508430935
Name:DANIELS, ELAINA RENEE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINA
Middle Name:RENEE
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELAINA
Other - Middle Name:RENEE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPARTMENT OF PATHOLOGY
Mailing Address - Street 2:2800 PLYMOUTH RD #35-1411
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2800
Mailing Address - Country:US
Mailing Address - Phone:734-764-3270
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PATHOLOGY
Practice Address - Street 2:2800 PLYMOUTH RD #35-1411
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2800
Practice Address - Country:US
Practice Address - Phone:734-764-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351047816390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program