Healthcare Provider Details

I. General information

NPI: 1144966409
Provider Name (Legal Business Name): ELANA KATHRYN PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 W 13 MILE RD STE 140
ROYAL OAK MI
48073-6770
US

IV. Provider business mailing address

3535 W 13 MILE RD STE 140
ROYAL OAK MI
48073-6770
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3000
  • Fax:
Mailing address:
  • Phone: 248-551-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301517843
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: