Provider Demographics
NPI:1972812741
Name:PERKINS, ELAINE ASHLEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ASHLEY
Last Name:PERKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:32255 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1566
Mailing Address - Country:US
Mailing Address - Phone:248-587-2300
Mailing Address - Fax:248-945-0492
Practice Address - Street 1:5716 MICHIGAN AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48210-3039
Practice Address - Country:US
Practice Address - Phone:313-554-1095
Practice Address - Fax:313-899-3560
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1972812741Medicaid
MIH06012079Medicare PIN
MI1972812741Medicaid
MIH06012079Medicare PIN
MI1235131137OtherBCBSM - PAW PAW
MI1417961137OtherBCBS BRONSON