MEDICARE: IHA OOMA PRIMARY LLC

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1780470179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHA OOMA PRIMARY LLC

Provider Business Mailing Address
First Line	:	24 FRANK LLOYD WRIGHT DR STE J2000
Second Line	:
City	:	ANN ARBOR
State	:	MI
Zip	:	48105-9484
Country	:	US
Telephone Number	:	734-747-6766
Fax Number	:	734-222-3100

Provider Business Practice Location Address
First Line	:	4123 MARTIN RD STE 102
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48390-4151
Country	:	US
Telephone Number	:	248-366-3700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CYNTHIA A ELLIOTT
Credential	:
Telephone Number	:	734-747-6766

Provider Enumeration Date	:	04/15/2025
Last Update Date	:	04/15/2025

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Directions to “IHA OOMA PRIMARY LLC ” Practice Location

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