Healthcare Provider Details

I. General information

NPI: 1629243290
Provider Name (Legal Business Name): MARCEL R ELANJIAN D O. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 MONROE ST
DEARBORN MI
48124-2922
US

IV. Provider business mailing address

2151 MONROE ST
DEARBORN MI
48124-2922
US

V. Phone/Fax

Practice location:
  • Phone: 313-561-5050
  • Fax: 313-561-6061
Mailing address:
  • Phone: 313-561-5050
  • Fax: 313-561-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME007858
License Number StateMI

VIII. Authorized Official

Name: MARCEL RICHARD ELANJIAN
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 313-561-6060