Provider Demographics
NPI:1780856393
Name:REUBEN D ELIUK, DO, PLC
Entity Type:Organization
Organization Name:REUBEN D ELIUK, DO, PLC
Other - Org Name:REUBEN D ELIUK, DO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELIUK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-421-4850
Mailing Address - Street 1:6255 INKSTER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-2577
Mailing Address - Country:US
Mailing Address - Phone:734-421-4850
Mailing Address - Fax:734-421-6635
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2577
Practice Address - Country:US
Practice Address - Phone:734-421-4850
Practice Address - Fax:734-421-6635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP17110001OtherMEDICARE PROVIDER NUMBER
MI1205987724OtherINDIVIDUAL NPI
MI1780856393OtherGROUP NPI
MI1205987724OtherINDIVIDUAL NPI
MIP17110001OtherMEDICARE PROVIDER NUMBER