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Organization
TRIPLE T MEDICAL PC
Active
Organization
TRIPLE T MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARD ELLISON JR. MD (OWNER)
(313) 342-9255
Entity
Organization
Contact information
Practice address
17187 SCHAEFER HWY, DETROIT, MI 48235-4132
(313) 342-9255
(313) 342-8489
Mailing address
17187 SCHAEFER HWY, DETROIT, MI 48235-4132
(313) 342-9255
(313) 342-8489
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301058406
MI
207R00000X
Internal Medicine Physician
4301053315
MI
207R00000X
Internal Medicine Physician
4301066816
MI
207R00000X
Internal Medicine Physician
Primary
4301068024
MI
208000000X
Pediatrics Physician
4301053315
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942539598
—
MI
01
—
500H258510
BCBS NP GROUP NUMBER
MI
01
—
700H258460
BCBS GROUP
MI
Enumeration date
12/10/2009
Last updated
06/01/2010
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