MEDICARE: ROBERT JOSEPH ELWELL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	171M00000X	Case Manager/Care Coordinator
3	363A00000X	Physician Assistant
4	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1629843800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT JOSEPH ELWELL

Provider Business Mailing Address
First Line	:	7805 COOLEY LAKE RD STE 200
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-3516
Country	:	US
Telephone Number	:	248-301-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	7805 COOLEY LAKE RD STE 300
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48324-3535
Country	:	US
Telephone Number	:	248-301-5585
Fax Number	:

Authorized Official
Title or Position	:	OWNER/AUTHORIZED OFFICIAL
Name	:	ROBERT J ELWELL
Credential	:	MA, LLP
Telephone Number	:	248-301-5585

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	12/08/2025

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