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1164468500

NPI Code Detail

MEDICARE: EVETTE N ELSENETY MD

MEDICARE: EVETTE N ELSENETY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	035480	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220021537	OTHER		RR MC
2	382032989	OTHER		TAX ID#
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2206325081	OTHER		BS
6	P00422257	OTHER		RRMC

General Provider Information

NPI Number	:	1164468500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVETTE N ELSENETY MD

Provider Business Mailing Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	27351 DEQUINDRE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-3487
Country	:	US
Telephone Number	:	248-967-7750
Fax Number	:	248-967-7297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	10/31/2013

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Directions to “ EVETTE N ELSENETY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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