Most Relevant Information
Provider Data
| NPI Number: | 1003341041 |
| Provider Name: | MAXINE ELLISON M.A. |
| Entity Type: | Individual |
| Taxonomy Code: | 247200000X |
| Specialty: | Technician, Other |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/27/2017 |
| Last Updated: | 04/27/2017 |
Provider Practice Location
41521 W 11 MILE RD
NOVI
MI
483751803
Practice Location Phone/Fax
| Phone: | 2482990030 |
| Fax: |
Provider Mailing Location
41521 W 11 MILE RD
NOVI
MI
483751803
Provider Mailing Phone/Fax
| Phone: | 2482990030 |
| Fax: |