Provider Demographics
NPI:1649041831
Name:RAINA M ERNSTOFF MD PLLC
Entity type:Organization
Organization Name:RAINA M ERNSTOFF MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAINA
Authorized Official - Middle Name:MARCIA
Authorized Official - Last Name:ERNSTOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-435-5700
Mailing Address - Street 1:4555 PRIVATE LAKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48301
Mailing Address - Country:US
Mailing Address - Phone:248-435-5700
Mailing Address - Fax:248-435-3128
Practice Address - Street 1:3535 W 13 MILE RD, SUITE 747
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-435-5700
Practice Address - Fax:248-435-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty