Provider Demographics
NPI:1053583047
Name:MICHAEL D ELDER MD INC
Entity type:Organization
Organization Name:MICHAEL D ELDER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-272-9644
Mailing Address - Street 1:1111 N LEE AVE
Mailing Address - Street 2:SUITE 236
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-2600
Mailing Address - Country:US
Mailing Address - Phone:405-272-9644
Mailing Address - Fax:405-272-0361
Practice Address - Street 1:1111 N LEE AVE
Practice Address - Street 2:SUITE 236
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2600
Practice Address - Country:US
Practice Address - Phone:405-272-9644
Practice Address - Fax:405-272-0361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14210207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR235485700OtherDEPT OF LABOR
050090950OtherRR MEDICARE
OKD34609Medicare UPIN
050090950OtherRR MEDICARE