Individual
MICHAEL J ELLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
28455 HAGGERTY RD, 200, NOVI, MI 48377-2982
(248) 893-3200
Mailing address
28455 HAGGERTY RD STE 200, NOVI, MI 48377-2982
(248) 893-3200
(248) 893-2950
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
4301086085
MI
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301086085
MI
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
4301086085
MI
208VP0014X
Interventional Pain Medicine Physician
4301086085
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301086085
STATE LISC
MI
01
—
9310121
BCBSM PIN
MI
Enumeration date
03/15/2007
Last updated
03/14/2025
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