Basic Information
| Provider Information | |||||||||
| NPI: | 1053416081 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STONE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MARJORIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4936 WEST CLARK RD. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344343000 | ||||||||
| FaxNumber: | 7344348040 | ||||||||
| Practice Location | |||||||||
| Address1: | 4936 WEST CLARK RD. | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344343000 | ||||||||
| FaxNumber: | 7344348040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 12/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301044722 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.