MEDICARE: DEFNE ELISE ILDIZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180.018061	IL
2	101YM0800X	Mental Health Counselor	6401226114	MI

General Provider Information

NPI Number	:	1487333498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEFNE ELISE ILDIZ

Provider Business Mailing Address
First Line	:	3722 SUNSET BLVD
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48324-2957
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3722 SUNSET BLVD
Second Line	:
City	:	ORCHARD LAKE
State	:	MI
Zip	:	48324-2957
Country	:	US
Telephone Number	:	609-721-2350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	05/06/2026

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Directions to “ DEFNE ELISE ILDIZ ” Practice Location

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