DR. ELINE HAENEBALCKE WILSON (NPI# 1174730444) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174730444 |
| Entity Type | Individual |
| Full Name | DR. ELINE HAENEBALCKE WILSON |
| Other Name | ELINE HAENEBALCKE |
| Credential | MD |
| Practice Address |
3750 Woodward Ave Ste 200c Detroit MI 48201-2007 |
| Mailing Address |
1420 Stephenson Hwy Suite 400-credentialing Troy MI 48083-1189 |
| Practice Telephone | 3139934645 |
| Practice Fax Number | 3139934654 |
| Mailing Telephone | 2485815970 |
| Mailing Fax Number | 2485815640 |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2014-02-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | 4301100277 | MI | Allopathic & Osteopathic Physicians |
| N | 207V00000X | Obstetrics & Gynecology | A116814 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
3750 WOODWARD AVE STE 200C |
| City | DETROIT |
| State | MI |
| Zip Code | 48201-2007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013984236 | David Bryant Jr. | Obstetrics & Gynecology | 3750 Woodward Ave, Suite 200c, Detroit, MI 48201-2007 | 2006-03-07 |
| 1427411859 | Lisa Marie Laberge | Student in an Organized Health Care Education/Training Program | 3750 Woodward Ave, Suite 200 A, Detroit, MI 48201-2007 | 2016-04-02 |
| 1700155272 | Lynette Patrice Carroll | Advanced Practice Midwife | 3750 Woodward Ave, Suite 200c, Detroit, MI 48201-2007 | 2011-12-29 |
| 1205144540 | Angela Chiodo | Advanced Practice Midwife | 3750 Woodward Ave, Suite 200c, Detroit, MI 48201-2007 | 2010-09-21 |
| 1255645487 | Jimmy Belotte | Obstetrics & Gynecology | 3750 Woodward Ave, Ste 200c, Detroit, MI 48201-2007 | 2010-07-29 |
| 1699921775 | Deslyn Theola Gloria Hobson | Obstetrics & Gynecology | 3750 Woodward Ave, Suite 200c, Detroit, MI 48201-2007 | 2008-08-08 |
| 1821259664 | Brian Mcclatchey | Social Worker | 3750 Woodward Ave, Detroit, MI 48201-2007 | 2008-06-24 |
| 1376704759 | Neil Simmerman | Obstetrics & Gynecology | 3750 Woodward Ave, Ste 200c, Detroit, MI 48201-2007 | 2008-06-19 |
| 1841495249 | Mordechai Hallak | Obstetrics & Gynecology | 3750 Woodward Ave, Ste 200c, Detroit, MI 48201-2007 | 2007-06-18 |
| 1326172107 | University Women's Care | Advanced Practice Midwife | 3750 Woodward Ave, Suite 200-c, Detroit, MI 48201-2007 | 2007-03-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659989838 | Saima Sharif | Student in an Organized Health Care Education/Training Program | 4201 St Antoine St 9c-uhc Detroit Education & Research, Detroit, MI 48201 | 2020-07-14 |
| 1609494384 | Praveen Kumar Boddu | Student in an Organized Health Care Education/Training Program | 3901,beaubien, Ste 3t72, Children's Hospital, Detroit, MI 48201 | 2020-07-09 |
| 1730707720 | Amr Hassan Abdelghaffar Omar | Pediatrics | 3901 Beaubien St Room 3t72, Children's Hospital of Michigan, Detroit, MI 48201 | 2020-07-07 |
| 1700400694 | Hassan Imtiaz | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine 8c-uhc, Detroit Medical Center, Detroit, MI 48201 | 2020-06-05 |
| 1598389074 | Alaa Awad Elkarim | Student in an Organized Health Care Education/Training Program | 3901 Beaubien St. 3t72, Detroit, MI 48201 | 2020-06-01 |
| 1891319299 | Jeongyeon Hwang | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street University Health Center - 8c, Detroit, MI 48201 | 2020-06-01 |
| 1477176576 | Jaudat Fatima Masood | Student in an Organized Health Care Education/Training Program | 4201 St Antoine Street, University Health Center - 8c, Detroit, MI 48201 | 2020-05-22 |
| 1205459419 | Amit Kumar Dahiya | Student in an Organized Health Care Education/Training Program | 11201 St. Antoine, Room 2e Uhc, Detroit, MI 48201 | 2020-05-21 |
| 1851914188 | Asra Nausheen Shaik | Student in an Organized Health Care Education/Training Program | 4201 St. Antoine St, Room 2e-uhc, Detroit, MI 48201 | 2020-05-21 |
| 1568085751 | Camille Olechowski | Student in an Organized Health Care Education/Training Program | 3901 Chrysler Dr. Detroit Medical Center, Room 5-a 538.1, Detroit, MI 48201 | 2020-05-21 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992009955 | Maurice-andre Recanati | Obstetrics & Gynecology | 4201 Saint Antoine St Ste 4c, Detroit, MI 48201-2153 | 2011-01-06 |
| 1194041830 | Eberechukwu Jill Azumah | Obstetrics & Gynecology | 5960 Bedford St, Detroit, MI 48224-2651 | 2010-04-19 |
| 1134383508 | Haider S Mahdi | Obstetrics & Gynecology | 3990 John R, 7 Brush North, Wayne State University/ Detroit Medical Center,obgyn, Detroit, MI 48201 | 2008-07-15 |
| 1609040484 | Yhfmc PC | Obstetrics & Gynecology | 15266 Grand River Ave, Detroit, MI 48227-2213 | 2008-04-14 |
| 1619191954 | F Seabrooks | Obstetrics & Gynecology | 19305 W 7 Mile Rd, Detroit, MI 48219-2718 | 2007-04-11 |
| 1326168188 | Mary Ibe | Obstetrics & Gynecology | 3980 John R, Detroit, MI 48201 | 2007-03-29 |
| 1144365545 | George W Gibson | Obstetrics & Gynecology | 15201 W Mcnichols Rd, Detroit, MI 48235-3717 | 2007-02-21 |
| 1780764712 | Romeo H Tabbilos | Obstetrics & Gynecology | 3011 West Grand Boulevard, Suite 428, Detroit, MI 48202 | 2006-10-16 |
| 1497862189 | Terry A Wynn | Obstetrics & Gynecology | 14103 Fenkell St, Detroit, MI 48227-3214 | 2006-08-25 |
| 1104856897 | Ann R Gillett-elrington | Obstetrics & Gynecology | 13901 E Jefferson Ave, Detroit, MI 48215-2720 | 2006-07-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.