Basic Information
| Provider Information | |||||||||
| NPI: | 1679574107 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELFRING | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 HASLETT RD | ||||||||
| Address2: | |||||||||
| City: | HASLETT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488407615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173747600 | ||||||||
| FaxNumber: | 5173749042 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 HASLETT RD | ||||||||
| Address2: | |||||||||
| City: | HASLETT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488407615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173747600 | ||||||||
| FaxNumber: | 5173749042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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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 | 207Q00000X | CE012450 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8533115640 | 01 | MI | BCBS | OTHER | 114523092 | 05 | MI | MEDICAID |