Individual
MATTHEW S ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5635 W FORT ST, DETROIT, MI 48209-3154
(313) 849-3920
Mailing address
20905 GREENFIELD RD STE 200, SOUTHFIELD, MI 48075-5346
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
5101027064
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/16/2020
Last updated
09/03/2022
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