Healthcare Provider Details

I. General information

NPI: 1568469294
Provider Name (Legal Business Name): ERROL GLENN ELRINGTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26611 W 7 MILE RD SUITE B
REDFORD MI
48240-2063
US

IV. Provider business mailing address

6895 RELIABLE PARKWAY #6895
CHICAGO IL
60688-0001
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-8419
  • Fax: 313-255-3671
Mailing address:
  • Phone: 313-255-6500
  • Fax: 313-255-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301030303
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: