Individual
ELISHEVA ELLENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11800 E 12 MILE RD, WARREN, MI 48093-3472
(773) 517-7931
Mailing address
16986 HILTON ST, SOUTHFIELD, MI 48075-1915
(773) 517-7931
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704311157
MI
Other
Enumeration date
05/12/2020
Last updated
05/12/2020
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