Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 5101017735 | MI |
NPI | 1023272267 |
---|---|
Provider Name | Elana Ann Grier |
First Address | Clinton Township, MI 48038-1266 |
Second Address | Clinton Township, MI 48038-3504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 16/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5101017735 | STATE LISCENCE (01) | MI |