Provider Demographics
NPI:1740213115
Name:ELIE, VINCENT R (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:R
Last Name:ELIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1034
Mailing Address - Country:US
Mailing Address - Phone:734-417-7054
Mailing Address - Fax:
Practice Address - Street 1:211 E MIDDLE ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1034
Practice Address - Country:US
Practice Address - Phone:734-417-7054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIVE057786207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI108123621OtherBCBSM
MION 26970OtherMEDICARE IDENTIFICATION NUMBER
MI4284888Medicaid
MIVE057786OtherMEDICAL LICENSE
MIF98022Medicare UPIN