MEDICARE: DR. ELLIOTT I GREENSPAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5101005633	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003803966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOTT I GREENSPAN D.O.

Provider Business Mailing Address
First Line	:	6962 SPRUCE HILL CT
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3704
Country	:	US
Telephone Number	:	248-245-4833
Fax Number	:	248-737-0159

Provider Business Practice Location Address
First Line	:	6962 SPRUCE HILL CT
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3704
Country	:	US
Telephone Number	:	248-245-4833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	06/28/2022

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