Provider Demographics
NPI:1457354482
Name:ELLER, BRIAN T (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:ELLER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3165 DUNES VALLEY PATH
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9368
Mailing Address - Country:US
Mailing Address - Phone:269-556-9739
Mailing Address - Fax:269-556-9924
Practice Address - Street 1:3078 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8608
Practice Address - Country:US
Practice Address - Phone:269-428-4620
Practice Address - Fax:269-428-4625
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIX207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE04886Medicare UPIN