Individual
JUSTIN ELIJAH TRIVAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
31500 TELEGRAPH RD, SUITE 115, BINGHAM FARMS, MI 48025-4367
(248) 594-4913
(248) 594-4928
Mailing address
29992 NORTHWESTERN HWY, SUITE C, FARMINGTON HILLS, MI 48334-3292
(248) 851-1430
(248) 851-5182
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301081886
MI
207RC0000X
Cardiovascular Disease Physician
Primary
4301081886
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174566095
—
MI
01
—
700H273300
BLUE SHIELD
MI
Enumeration date
06/14/2006
Last updated
12/20/2012
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