Provider Demographics
NPI:1780630905
Name:ELKUS, ROBIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:ELKUS
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 1:44555 WOODWARD AVE STE 504
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5039
Mailing Address - Country:US
Mailing Address - Phone:248-858-9624
Mailing Address - Fax:248-858-9625
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:STE 504
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341
Practice Address - Country:US
Practice Address - Phone:248-858-9624
Practice Address - Fax:248-858-9625
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI430155958207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H273300OtherBCBSM GROUP PIN MHP
MI4262998Medicaid
MIDS0605OtherRAIL ROAD MEDICARE GROUP PIN MHP
MIMI4989OtherMEDICARE GROUP PIN MHP
MIMI4989141Medicare PIN
MI4262998Medicaid
MI0F363740Medicare ID - Type UnspecifiedMEDICARE COMMON #