Provider Demographics
NPI:1598784480
Name:COCCITTI, ELLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:COCCITTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HAGGERTY RD
Mailing Address - Street 2:SUITE 2060
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2184
Mailing Address - Country:US
Mailing Address - Phone:248-960-4245
Mailing Address - Fax:248-960-7733
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 2060
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-960-4245
Practice Address - Fax:248-960-7733
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4357877Medicaid
MI4357877Medicaid
0E06280037Medicare PIN