Individual
MD ILIAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-4807
Mailing address
3410 CARPENTER ST APT 2F, DETROIT, MI 48212-2770
(313) 966-4807
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4351053372
MI
Other
Enumeration date
04/06/2016
Last updated
07/03/2024
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