Provider Demographics
NPI:1992032007
Name:MAHIR D ELDER MD PC
Entity Type:Organization
Organization Name:MAHIR D ELDER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHIR
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-993-7777
Mailing Address - Street 1:4160 JOHN R ST STE 510
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2021
Mailing Address - Country:US
Mailing Address - Phone:313-993-7777
Mailing Address - Fax:313-993-2563
Practice Address - Street 1:4160 JOHN R ST STE 510
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2021
Practice Address - Country:US
Practice Address - Phone:313-999-2222
Practice Address - Fax:313-993-2563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIME073824207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI105174942Medicaid
MII60238OtherUPIN