Individual
SUSAN EDLIBI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2689
(313) 916-4988
Mailing address
2799 W GRAND BLVD, DETROIT, MI 48202-2689
(313) 916-4988
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301114536
MI
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
43510399878
MI
208000000X
Pediatrics Physician
4301114536
MI
2080P0201X
Pediatric Allergy/Immunology Physician
43510399878
MI
Other
Enumeration date
06/20/2018
Last updated
06/30/2022
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