Organization
EVO BODY IMAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SIDRA S ELIA MD (ORGANIZER)
(248) 595-2363
Entity
Organization
Contact information
Practice address
950 E MAPLE RD STE L10, BIRMINGHAM, MI 48009-6482
(248) 595-2363
Mailing address
6642 LEYTONSTONE BLVD, WEST BLOOMFIELD, MI 48322-1200
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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