Healthcare Provider Details

I. General information

NPI: 1760489348
Provider Name (Legal Business Name): ELLEN BETH OZOLINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN BETH OZOLINS-TRAVIS MD

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44050 W 12 MILE RD
NOVI MI
48377-2612
US

IV. Provider business mailing address

44050 W 12 MILE RD
NOVI MI
48377-2612
US

V. Phone/Fax

Practice location:
  • Phone: 248-735-3800
  • Fax: 248-308-2155
Mailing address:
  • Phone: 248-735-3800
  • Fax: 248-308-2155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberEO065676
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberEO065676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: