Provider Demographics
NPI:1770759649
Name:NERBUN, ELIZABETH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:NERBUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SR. MARY RACHEL
Other - Middle Name:
Other - Last Name:NERBUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2025 W CHEESMAN RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-9760
Mailing Address - Country:US
Mailing Address - Phone:989-463-3451
Mailing Address - Fax:989-463-1534
Practice Address - Street 1:2025 W CHEESMAN RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9760
Practice Address - Country:US
Practice Address - Phone:989-463-3451
Practice Address - Fax:989-463-1534
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1770759649Medicaid
MI1770759649Medicaid