Individual
BURTON ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6825 HEIRLOOM CIR, WEST BLOOMFIELD, MI 48322-4805
(248) 497-1234
Mailing address
6825 HEIRLOOM CIR, WEST BLOOMFIELD, MI 48322-4805
(248) 497-1234
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301030106
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2849514
—
MI
01
—
300F362420
BCBSM
MI
Enumeration date
03/22/2006
Last updated
07/17/2024
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