Basic Information
| Provider Information | |||||||||
| NPI: | 1912969700 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERIK | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 S BALLENGER HWY | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485323638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103421000 | ||||||||
| FaxNumber: | 8103421590 | ||||||||
| Practice Location | |||||||||
| Address1: | 2316 S CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489103152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177024300 | ||||||||
| FaxNumber: | 5177024301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 01/21/2014 | ||||||||
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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 | 207V00000X | 5101014624 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1016412 | 01 | MI | MCLAREN HEALTH PLAN | OTHER | 160C311260 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 4794596 | 05 | MI | MEDICAID | 7897757 | 01 | MI | AETNA | OTHER | 160C311260 | 01 | MI | BLUE CHOICE | OTHER | 1653311355 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 1016412 | 01 | MI | HEALTH ADVANTAGE | OTHER | 160C311260 | 01 | MI | BLUE CARE NETWORK | OTHER | I44110 | 01 | MI | HEALTH NET FEDERAL SERVIC | OTHER | 0700436 | 01 | MI | PHYSICIANS HEALTH PLAN | OTHER | 160C311260 | 01 | MI | COMMUNITY CHOICE | OTHER |