Provider Demographics
NPI:1255363388
Name:TRI COUNTY ENDOCRINOLOGY & NUCLEAR MEDICINE PC
Entity type:Organization
Organization Name:TRI COUNTY ENDOCRINOLOGY & NUCLEAR MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ELANDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-294-4820
Mailing Address - Street 1:14049 E 13 MILE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-5876
Mailing Address - Country:US
Mailing Address - Phone:586-294-4820
Mailing Address - Fax:586-294-7881
Practice Address - Street 1:14049 E 13 MILE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-5876
Practice Address - Country:US
Practice Address - Phone:586-294-4820
Practice Address - Fax:586-294-7881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H26347OtherBCBS GRP NO
MI0H26347Medicare ID - Type UnspecifiedGRP NO
MI0H26347OtherBCBS GRP NO
MIG38020Medicare UPIN
MIF48058Medicare UPIN