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Organization
SANDRA L. ELLIS, MD, PLLC
Active
Organization
SANDRA L. ELLIS, MD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDRA LYNN ELLIS MD (PRESIDENT)
(248) 353-2600
Entity
Organization
Contact information
Practice address
19034 W 10 MILE RD, SOUTHFIELD, MI 48075-2401
(248) 353-2600
(248) 353-1367
Mailing address
6632 TELEGRAPH RD, STE 318, BLOOMFIELD HILLS, MI 48301-3012
(248) 353-2600
(248) 353-1367
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
SE070800
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104077793
—
MI
Enumeration date
07/09/2007
Last updated
04/20/2008
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