Organization
LEONARD ELLISON JR MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEONARD ELLISON JR. MD (OWNER/PHYSICIAN)
(248) 552-9500
Entity
Organization
Contact information
Practice address
17330 NORTHLAND PARK CT, SOUTHFIELD, MI 48075-4318
(248) 552-9500
(248) 552-8144
Mailing address
17330 NORTHLAND PARK CT, SOUTHFIELD, MI 48075-4318
(248) 552-9500
(248) 552-8144
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301068024
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110F312710
BCBS
MI
05
—
4709307
—
MI
01
—
500F382740
BCBS GROUP
MI
Enumeration date
05/22/2006
Last updated
12/27/2013
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