Provider Demographics
NPI:1750962692
Name:ELLIOTT, JEFFREY HUNTER (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HUNTER
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42350 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1838
Mailing Address - Country:US
Mailing Address - Phone:248-697-2942
Mailing Address - Fax:248-436-6628
Practice Address - Street 1:42350 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1838
Practice Address - Country:US
Practice Address - Phone:248-697-2942
Practice Address - Fax:248-436-6628
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301514544208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program