Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301102107 | MI |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 4301102107 | MI |
NPI | 1417113036 |
---|---|
Provider Name | Erik Brian Eller |
First Address | Phoenix, AZ 85023-1266 |
Second Address | Novi, MI 48374-1212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2008 |
Last Update Date | 21/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PO1223793 | MEDICARE RAILROAD (01) | MI |