Individual
DR. DOUGLAS MARTIN ELLINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301048999
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300E410190
BCBS GROUP PIN
MI
05
—
4560935
—
MI
01
—
DB9242
MEDICARE RR GROUP PIN
MI
Enumeration date
05/03/2006
Last updated
06/16/2009
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