Individual
DR. DAERYL DAVE ELGINCOLIN AMPONIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-5664
Mailing address
16001 W 9 MILE RD, SOUTHFIELD, MI 48075-4818
(248) 849-3000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4351050910
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2023
Last updated
04/28/2023
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