Provider Demographics
NPI:1629243290
Name:MARCEL R ELANJIAN D O. PLLC
Entity Type:Organization
Organization Name:MARCEL R ELANJIAN D O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ELANJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-561-6060
Mailing Address - Street 1:2151 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2922
Mailing Address - Country:US
Mailing Address - Phone:313-561-5050
Mailing Address - Fax:313-561-6061
Practice Address - Street 1:2151 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2922
Practice Address - Country:US
Practice Address - Phone:313-561-5050
Practice Address - Fax:313-561-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIME007858207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2116337Medicaid
MI2116337Medicaid
MIE39696Medicare UPIN