Healthcare Provider Details

I. General information

NPI: 1497506539
Provider Name (Legal Business Name): ASHRAF ELSISI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36475 FIVE MILE RD
LIVONIA MI
48154-1971
US

IV. Provider business mailing address

3529 SHERBOURNE RD
DETROIT MI
48221-1818
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-4800
  • Fax:
Mailing address:
  • Phone: 732-735-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301518638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: