Healthcare Provider Details

I. General information

NPI: 1770871154
Provider Name (Legal Business Name): HILAL D ELIA M.D., P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E STATE FAIR
DETROIT MI
48203-1273
US

IV. Provider business mailing address

950 E STATE FAIR
DETROIT MI
48203-1273
US

V. Phone/Fax

Practice location:
  • Phone: 313-366-3700
  • Fax: 313-366-2767
Mailing address:
  • Phone: 313-366-3700
  • Fax: 313-366-2767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number207R00000X
License Number StateMI

VIII. Authorized Official

Name: MRS. ELHAM F ELIA
Title or Position: OFFICE MANAGER
Credential:
Phone: 313-366-3700