Provider Demographics
NPI:1255398046
Name:ELIEFF, MICHELLE P (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:P
Last Name:ELIEFF
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 1:4840 F ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-1407
Mailing Address - Country:US
Mailing Address - Phone:402-731-4145
Mailing Address - Fax:402-731-8653
Practice Address - Street 1:4840 F ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-1407
Practice Address - Country:US
Practice Address - Phone:402-731-4145
Practice Address - Fax:402-731-8653
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059786A207ZP0105X, 207ZP0102X
IDM-9649207ZP0102X
NE26799207ZP0102X
MI4301091990207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI129910Medicare UPIN