Provider Demographics
NPI:1629001359
Name:ELROD, MICHAEL A (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:ELROD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3794
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8493
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR STE 130
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4094
Practice Address - Country:US
Practice Address - Phone:937-531-0195
Practice Address - Fax:937-531-0196
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008804208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7721889OtherAETNA
OHP00478009OtherRAIL ROAD MEDICARE
000000490751OtherBCBS-OH
OH2702954Medicaid
OH311175717OtherTRICARE HEALTHNET
OH421534506OtherHEALTHNET
OH4515730OtherCIGNA
OH000000823179OtherBCBS - ANTHEM PMG
OH311175717224OtherCARESOURCE
OH7721889OtherAETNA
OHEL7365571Medicare PIN
OH000000823179OtherBCBS - ANTHEM PMG
OHH206321Medicare PIN
OH2702954Medicaid
OHP00478009OtherRAIL ROAD MEDICARE
OHH206322Medicare PIN