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General NPI Number Information
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NPI Number | 1144767351
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Entity Type | Organization
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Legal Business Name | D.O.C DOCTORS ON CALL, PC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 17330 NORTHLAND PARK CT STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4319
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Country | US
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Telephone | 248-971-4880
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Fax |
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Provider Business Mailing Address
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Address Line | 17330 NORTHLAND PARK CT STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4319
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Country | US
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Telephone | 248-971-4880
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEONARD ELLISON JR.
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Credential | MD
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Telephone | 248-971-4880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 4301068024
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License Number State | MI
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