Provider Demographics
NPI:1154628204
Name:AT HOME PHYSICIANS, PC
Entity Type:Organization
Organization Name:AT HOME PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:313-477-9545
Mailing Address - Street 1:23155 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7703
Mailing Address - Country:US
Mailing Address - Phone:248-304-1700
Mailing Address - Fax:248-304-1720
Practice Address - Street 1:23155 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 401
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7703
Practice Address - Country:US
Practice Address - Phone:248-304-1700
Practice Address - Fax:248-304-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty