Healthcare Provider Details

I. General information

NPI: 1710208947
Provider Name (Legal Business Name): ASHRAF M ELBANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E WILLIAMS ST
OWOSSO MI
48867-2360
US

IV. Provider business mailing address

113 E WILLIAMS ST
OWOSSO MI
48867-2360
US

V. Phone/Fax

Practice location:
  • Phone: 989-725-6101
  • Fax: 989-723-3601
Mailing address:
  • Phone: 989-725-6101
  • Fax: 989-723-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301097084
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: