Provider Demographics
NPI:1730293176
Name:ELODY, MARTA STEFANIA (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:STEFANIA
Last Name:ELODY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:47274 HUNTERS PARK DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3098
Mailing Address - Country:US
Mailing Address - Phone:734-285-8282
Mailing Address - Fax:734-281-0402
Practice Address - Street 1:20600 EUREKA RD STE 819
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-5377
Practice Address - Country:US
Practice Address - Phone:734-285-8282
Practice Address - Fax:734-281-0405
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010299162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry