Individual
BRIAN EELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3901 BEAUBIEN ST, DETROIT, MI 48201-2119
(952) 442-9770
Mailing address
PO BOX 67000, DEPT 203401, DETROIT, MI 48267-0002
(952) 442-9770
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704213639
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104300972
—
MI
01
—
527892243
TRICARE
MI
01
—
BE213639
BLUE CROSS
MI
Enumeration date
08/26/2005
Last updated
08/25/2008
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