Organization
ELIAS G GENNAOUI M.D. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIAS G GENNAOUI M.D. (OWNER)
(313) 386-3930
Entity
Organization
Contact information
Practice address
14825 SOUTHFIELD RD, ALLEN PARK, MI 48101-2642
(313) 386-3930
(313) 386-0962
Mailing address
14825 SOUTHFIELD RD, ALLEN PARK, MI 48101-2642
(313) 386-3930
(313) 386-0962
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
EG037248
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3442150
—
MI
Enumeration date
04/22/2008
Last updated
04/22/2008
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