Provider Demographics
NPI:1134170384
Name:ELYAS, NAHID D (MD)
Entity type:Individual
Prefix:DR
First Name:NAHID
Middle Name:D
Last Name:ELYAS
Suffix:
Gender:M
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:PO BOX 250213
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0213
Mailing Address - Country:US
Mailing Address - Phone:248-539-0729
Mailing Address - Fax:248-539-0740
Practice Address - Street 1:30055 NORTHWESTERN HWY
Practice Address - Street 2:SUIT #170
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3230
Practice Address - Country:US
Practice Address - Phone:248-539-0729
Practice Address - Fax:248-539-0740
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MINE066443207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4607998Medicaid
MIG74378Medicare UPIN
MI0N91330Medicare ID - Type Unspecified