=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891025870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMERCE TOWNSHIP PSYCHIATRY,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2010
-----------------------------------------------------
Last Update Date | 01/13/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6021 CARROLL LAKE RD
-----------------------------------------------------
City | COMMERCE TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48382-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-225-7232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6021 CARROLL LAKE RD
-----------------------------------------------------
City | COMMERCE TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48382-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-225-7232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. ELIZABETH J ELDON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 248-225-7232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0805X
-----------------------------------------------------
Taxonomy Name | Geriatric Psychiatry Physician
-----------------------------------------------------
License Number | 4301407071
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------