Provider Demographics
NPI:1861485500
Name:ELANJIAN, MARCEL (DO)
Entity type:Individual
Prefix:DR
First Name:MARCEL
Middle Name:
Last Name:ELANJIAN
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 1:2151 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2922
Mailing Address - Country:US
Mailing Address - Phone:313-561-6060
Mailing Address - Fax:313-561-6061
Practice Address - Street 1:2151 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2922
Practice Address - Country:US
Practice Address - Phone:313-561-6060
Practice Address - Fax:313-561-6061
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI007858207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2116337Medicaid
MIE39696Medicare UPIN
MI2116337Medicaid