Basic Information
| Provider Information | |||||||||
| NPI: | 1629001359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELROD | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 PRESTIGE PL | ||||||||
| Address2: | SUITE 550 | ||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453423794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377621310 | ||||||||
| FaxNumber: | 9375228493 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 WASHINGTON VILLAGE DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | CENTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454594094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375310195 | ||||||||
| FaxNumber: | 9375310196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2006 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 34008804 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7721889 | 01 | OH | AETNA | OTHER | P00478009 | 01 | OH | RAIL ROAD MEDICARE | OTHER | 000000490751 | 01 | BCBS-OH | OTHER | 2702954 | 05 | OH | MEDICAID | 311175717 | 01 | OH | TRICARE HEALTHNET | OTHER | 421534506 | 01 | OH | HEALTHNET | OTHER | 4515730 | 01 | OH | CIGNA | OTHER | 000000823179 | 01 | OH | BCBS - ANTHEM PMG | OTHER | 311175717224 | 01 | OH | CARESOURCE | OTHER |