Healthcare Provider Details

I. General information

NPI: 1073509857
Provider Name (Legal Business Name): WILLIAM W. EHRLICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19176 HALL RD STE 110
CLINTON TOWNSHIP MI
48038-6914
US

IV. Provider business mailing address

30150 TELEGRAPH RD STE 271
BINGHAM FARMS MI
48025-4521
US

V. Phone/Fax

Practice location:
  • Phone: 586-286-3400
  • Fax: 862-863-6195
Mailing address:
  • Phone: 313-530-5494
  • Fax: 205-943-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number4301043309
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: