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General NPI Number Information
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NPI Number | 1104222017
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Entity Type | Organization
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Legal Business Name | MI BODY CONTOUR
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 17000 EXECUTIVE PLAZA DR SUITE #204
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City | DEARBORN
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State | MI
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Zip | 48126
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Country | US
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Telephone | 313-846-7970
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Fax | 888-304-1293
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Provider Business Mailing Address
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Address Line | 12740 W WARREN AVE STE 102
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City | DEARBORN
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State | MI
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Zip | 48126-4530
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Country | US
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Telephone | 313-846-7970
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Fax | 888-304-1293
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Authorized Official
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Title or Position | PROVIDER
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Name | ALI ELHORR
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Credential | M.D
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Telephone | 313-304-6515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 4301080821
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License Number State | MI
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