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NPI Code Detail

MEDICARE: DR. ELAINA VAYNTRUB MD

MEDICARE: DR. ELAINA VAYNTRUB 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
1207R00000XInternal Medicine Physician4301073103MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770573958
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELAINA VAYNTRUB MD
Provider Business Mailing Address
First Line : 135 S PROSPECT ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-7914
Country : US
Telephone Number : 734-547-1066
Fax Number : 734-547-1072
Provider Business Practice Location Address
First Line : 135 S PROSPECT ST
Second Line :
City : YPSILANTI
State : MI
Zip : 48198-7914
Country : US
Telephone Number : 734-547-1066
Fax Number : 734-547-1072
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 05/11/2015

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Directions to “ DR. ELAINA VAYNTRUB MD” Practice Location

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