Individual
LISA B. ELCONIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5777 W MAPLE RD, SUITE 140, WEST BLOOMFIELD, MI 48322-2267
(248) 406-1000
(248) 406-1001
Mailing address
5777 W MAPLE RD, SUITE 140, WEST BLOOMFIELD, MI 48322-2267
(248) 406-1000
(248) 406-1001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301060119
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4619246
—
MI
Enumeration date
03/01/2006
Last updated
08/05/2011
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