Elder, Jack S

Elder, Jack S is an individual health care provider with primary practice located at 2799 W Grand Blvd , Detroit MI 48202-2608. He recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as his primary health care specialty. Elder, Jack S can be contacted via phone (313) 916-2600.

Contact Information

Primary practice address
2799 W Grand Blvd Detroit MI 48202-2608
Phone: (313) 916-2600
Fax: (313) 916-9539
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 35-053721 Ohio
Allopathic & Osteopathic Physicians / Urology 208800000X 4301072611 Michigan

Profile Details

NPI number 1457385072
LBN Legal business name Elder, Jack S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 10th, 2006
Last updated Jan 9th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1457385072 NPPES
Michigan Other 020H277290 BCBS
Michigan Other 1900370 BCBS
Michigan MEDICAID 0633587 BCBS
Michigan Other 000000026163 BCBS
Michigan Other 1396817714 BCBS
Michigan MEDICAID 001953975002 BCBS
Michigan MEDICAID 5196618 BCBS
Michigan Other P00388789 BCBS

Popular Providers