Individual
IDIL EZHUTHACHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3601 W 13 MILE RD, ROYAL OAK, MI 48073-6712
(248) 551-2040
(248) 898-9677
Mailing address
130 TOWN CENTER DR, STE 203, TROY, MI 48084-1744
(248) 551-2040
(248) 898-9677
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
4301105270
MI
Other
Enumeration date
07/03/2014
Last updated
02/12/2018
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