MEDICARE: MS. ELLEN BETH OZOLINS MD

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	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	EO065676	MI
2	2086S0122X	Plastic and Reconstructive Surgery Physician	EO065676	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	:	1760489348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN BETH OZOLINS MD

Provider Business Mailing Address
First Line	:	44050 W 12 MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-2612
Country	:	US
Telephone Number	:	248-735-3800
Fax Number	:	248-308-2155

Provider Business Practice Location Address
First Line	:	44050 W 12 MILE RD
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48377-2612
Country	:	US
Telephone Number	:	248-735-3800
Fax Number	:	248-308-2155

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	06/16/2018

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