Basic Information
| Provider Information | |||||||||
| NPI: | 1033559729 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRUCCO | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1217 MORNINGSIDE DR | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481032522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342320241 | ||||||||
| FaxNumber: | 7349987992 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 E WASHINGTON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481042057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347633471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 06/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 6301015501 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.