Provider Demographics
NPI:1922457324
Name:ELDER, BADREA (MD)
Entity Type:Individual
Prefix:DR
First Name:BADREA
Middle Name:
Last Name:ELDER
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 1:50630 CHESTERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-4009
Mailing Address - Country:US
Mailing Address - Phone:947-523-3000
Mailing Address - Fax:947-523-3005
Practice Address - Street 1:50630 CHESTERFIELD RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-4009
Practice Address - Country:US
Practice Address - Phone:947-523-3000
Practice Address - Fax:947-523-3005
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301109641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine