MEDICARE: ELIZABETH A PENSLER DO PLLC

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	2086S0129X	Vascular Surgery Physician	5101017420	MI

General Provider Information

NPI Number	:	1255704805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH A PENSLER DO PLLC

Provider Business Mailing Address
First Line	:	PO BOX 71587
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-0587
Country	:	US
Telephone Number	:	586-751-3480
Fax Number	:	888-850-3877

Provider Business Practice Location Address
First Line	:	928 E 10 MILE RD STE 400
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-3041
Country	:	US
Telephone Number	:	248-268-4296
Fax Number	:	888-850-3877

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/OWNER
Name	:	ELIZABETH PENSLER
Credential	:	DO
Telephone Number	:	586-751-3480

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	07/25/2022

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