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General NPI Number Information
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NPI Number | 1063468387
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Entity Type | Organization
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Legal Business Name | DR. D. M. ELEM PC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 10/24/2008
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Provider Practice Location Address
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Address Line | 1111 FORT ST
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City | LINCOLN PARK
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State | MI
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Zip | 48146-1802
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Country | US
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Telephone | 313-386-0000
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Fax | 313-386-1597
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Provider Business Mailing Address
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Address Line | 1111 FORT ST
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City | LINCOLN PARK
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State | MI
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Zip | 48146-1802
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Country | US
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Telephone | 313-386-0000
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Fax | 313-386-1597
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DURENE MICHELLE ELEM-VAUGHN
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Credential | DPM
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Telephone | 313-386-0000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 5901001503
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License Number State | MI
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