Provider Demographics
NPI:1386746725
Name:MURRAY, ELISE (DO)
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:39500 W 10 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2947
Mailing Address - Country:US
Mailing Address - Phone:248-476-0035
Mailing Address - Fax:248-476-2418
Practice Address - Street 1:39500 W 10 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2947
Practice Address - Country:US
Practice Address - Phone:248-476-0035
Practice Address - Fax:248-476-2418
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1158202914OtherBCN IND
MI1158202914OtherBCBS IND
MI110236363OtherRAILROAD MEDICARE IND PIN
MI1386746725Medicaid
MI5940073OtherAETNA
MIG16535OtherHAP
MIG16535Medicare UPIN
MI5940073OtherAETNA