Provider Demographics
NPI:1760632962
Name:MONROE ARTHRITIS CLINIC PLLC
Entity Type:Organization
Organization Name:MONROE ARTHRITIS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-682-5524
Mailing Address - Street 1:730 N MACOMB ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2900
Mailing Address - Country:US
Mailing Address - Phone:734-682-5524
Mailing Address - Fax:
Practice Address - Street 1:730 N MACOMB ST
Practice Address - Street 2:SUITE 320
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2900
Practice Address - Country:US
Practice Address - Phone:734-682-5524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093250207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
EL7369971OtherMEDICARE
1104978048OtherIND NPI
OH2706316Medicaid
EL7369971OtherMEDICARE