Healthcare Provider Details

I. General information

NPI: 1629001359
Provider Name (Legal Business Name): MICHAEL A ELROD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 WASHINGTON VILLAGE DR STE 130
CENTERVILLE OH
45459-4094
US

IV. Provider business mailing address

1 PRESTIGE PL SUITE 550
MIAMISBURG OH
45342-3794
US

V. Phone/Fax

Practice location:
  • Phone: 937-531-0195
  • Fax: 937-531-0196
Mailing address:
  • Phone: 937-762-1310
  • Fax: 937-522-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34008804
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: