Provider Demographics
NPI:1104222017
Name:MI BODY CONTOUR
Entity Type:Organization
Organization Name:MI BODY CONTOUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELHORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-304-6515
Mailing Address - Street 1:12740 W WARREN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-4530
Mailing Address - Country:US
Mailing Address - Phone:313-846-7970
Mailing Address - Fax:888-304-1293
Practice Address - Street 1:17000 EXECUTIVE PLAZA DR SUITE #204
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-846-7970
Practice Address - Fax:888-304-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080821208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty