Provider Demographics
NPI:1255704805
Name:ELIZABETH A PENSLER DO PLLC
Entity type:Organization
Organization Name:ELIZABETH A PENSLER DO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PENSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-751-3480
Mailing Address - Street 1:PO BOX 71587
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-0587
Mailing Address - Country:US
Mailing Address - Phone:586-751-3480
Mailing Address - Fax:888-850-3877
Practice Address - Street 1:928 E 10 MILE RD STE 400
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-3041
Practice Address - Country:US
Practice Address - Phone:248-268-4296
Practice Address - Fax:888-850-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010174202086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDOtherALL INS PENDING