MEDICARE: DR. ELLEN COCCITTI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	5101012722	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598784480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN COCCITTI D.O.

Provider Business Mailing Address
First Line	:	2300 HAGGERTY RD
Second Line	:	SUITE 2060
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2184
Country	:	US
Telephone Number	:	248-960-4245
Fax Number	:	248-960-7733

Provider Business Practice Location Address
First Line	:	2300 HAGGERTY RD
Second Line	:	SUITE 2060
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323-2184
Country	:	US
Telephone Number	:	248-960-4245
Fax Number	:	248-960-7733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/04/2015

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Directions to “ DR. ELLEN COCCITTI D.O.” Practice Location

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