Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 5101005633 | MI |
Y | 111NI0900X | Internist | 5101005633 | MI |
NPI | 1003803966 |
---|---|
Provider Name | Dr. Elliott I Greenspan |
First Address | Livonia, MI 48150-1216 |
Second Address | Livonia, MI 48150-1216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2005 |
Last Update Date | 18/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1188028-11 | (05) | MI |
1791545-11 | (05) | MI |
3142396-11 | (05) | MI |
4865778-11 | (05) | MI |
E31652 | (02) | MI |