Provider Demographics
NPI:1205987724
Name:ELIUK, REUBEN DWAYNE (DO)
Entity type:Individual
Prefix:
First Name:REUBEN
Middle Name:DWAYNE
Last Name:ELIUK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 74
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8481
Mailing Address - Fax:269-341-7781
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:BOX 74
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8481
Practice Address - Fax:269-341-7781
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007332207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4754124Medicaid
MI0P17110OtherGROUP PIN
MI1235131137OtherBCBS - BLH
MI1205987724Medicaid
MI1417961137OtherBCBS BRONSON
MIP17110001OtherMEDICARE PROVIDER NUMBER
MIP17110001OtherMEDICARE PROVIDER NUMBER
MIC97618361 - BMHMedicare PIN
MI4754124Medicaid