Provider Demographics
NPI:1760463749
Name:AKKERMAN, ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:AKKERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26206 W 12 MILE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1754
Mailing Address - Country:US
Mailing Address - Phone:248-350-3434
Mailing Address - Fax:248-350-1490
Practice Address - Street 1:26206 W 12 MILE RD
Practice Address - Street 2:STE 300
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1754
Practice Address - Country:US
Practice Address - Phone:248-350-3434
Practice Address - Fax:248-350-1490
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI416040510Medicaid
MI700E012740OtherBCBS GROUP NUMBER
MI0N40170Medicare PIN
F58200Medicare UPIN
0M91700001Medicare PIN
MI416040510Medicaid