Healthcare Provider Details

I. General information

NPI: 1750962692
Provider Name (Legal Business Name): JEFFREY HUNTER ELLIOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42350 GRAND RIVER AVE
NOVI MI
48375-1838
US

IV. Provider business mailing address

42350 GRAND RIVER AVE
NOVI MI
48375-1838
US

V. Phone/Fax

Practice location:
  • Phone: 248-697-2942
  • Fax: 248-436-6628
Mailing address:
  • Phone: 248-697-2942
  • Fax: 248-436-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301514544
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: