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Organization

IHA OLMA SPECIALTY 1 LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CYNTHIA A ELLIOTT (PRESIDENT)
(734) 327-0872
Entity
Organization

Contact information

Practice address
36475 FIVE MILE RD, LIVONIA, MI 48154-1971
(734) 655-2692
(734) 655-4218
Mailing address
24 FRANK LLOYD WRIGHT DR STE J2000, ANN ARBOR, MI 48105-9484
(734) 747-6766
(734) 222-3100

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2086S0102X
Surgical Critical Care Physician
Primary

Other

Enumeration date
03/29/2022
Last updated
10/09/2023
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