=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629243290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARCEL R ELANJIAN D O. PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2008
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2151 MONROE ST
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48124-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-561-5050
-----------------------------------------------------
Fax | 313-561-6061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2151 MONROE ST
-----------------------------------------------------
City | DEARBORN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48124-2922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-561-5050
-----------------------------------------------------
Fax | 313-561-6061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | MARCEL RICHARD ELANJIAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 313-561-6060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | ME007858
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------