Individual
ANGELIQUE NIKKOL-TELYCENAS ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5400 FORT ST STE 250, TRENTON, MI 48183-4630
(734) 642-2480
(734) 642-2475
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1863
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
5101020652
MI
Other
Enumeration date
06/11/2013
Last updated
10/22/2020
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