Provider Demographics
NPI:1760489348
Name:OZOLINS, ELLEN BETH (MD)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:BETH
Last Name:OZOLINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:BETH
Other - Last Name:OZOLINS-TRAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:44050 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2612
Mailing Address - Country:US
Mailing Address - Phone:248-735-3800
Mailing Address - Fax:248-308-2155
Practice Address - Street 1:44050 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2612
Practice Address - Country:US
Practice Address - Phone:248-735-3800
Practice Address - Fax:248-308-2155
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEO0656762082S0099X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104422349Medicaid
MIH18640Medicare UPIN