Provider Demographics
NPI:1669499281
Name:BOYLE, ELAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 5TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1641
Mailing Address - Country:US
Mailing Address - Phone:810-406-4935
Mailing Address - Fax:810-234-7015
Practice Address - Street 1:225 E 5TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1641
Practice Address - Country:US
Practice Address - Phone:810-406-4935
Practice Address - Fax:810-234-7015
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004618 TEMP363A00000X
MI5601004618363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM57650038Medicare PIN
Q62770Medicare UPIN