Organization
DR. D. M. ELEM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DURENE MICHELLE ELEM-VAUGHN DPM (PRESIDENT)
(313) 386-0000
Entity
Organization
Contact information
Practice address
1111 FORT ST, LINCOLN PARK, MI 48146-1802
(313) 386-0000
(313) 386-1597
Mailing address
1111 FORT ST, LINCOLN PARK, MI 48146-1802
(313) 386-0000
(313) 386-1597
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
5901001503
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2710766
—
MI
01
—
4858252150
BLUE CROSS BLUE SHIELD MICHIGAN
MI
Enumeration date
05/26/2006
Last updated
10/24/2008
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