Sandra L. Ellis, MD, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

SE070800 Issued in MI

Legal business name

SANDRA L. ELLIS, MD, PLLC

Practice address

19034 W 10 Mile Rd
Southfield, MI 48075-2401

Phone

(248) 353-2600

Fax

(248) 353-1367

NPI assigned

Jul 9, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Sandra Lynn Ellis, MD

Title

President

Phone

(248) 353-2600

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1407054752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6632 TELEGRAPH RD",
            "address_2": "STE 318",
            "city": "BLOOMFIELD HILLS",
            "state": "MI",
            "postal_code": "483013012",
            "telephone_number": "248-353-2600",
            "fax_number": "248-353-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19034 W 10 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480752401",
            "telephone_number": "248-353-2600",
            "fax_number": "248-353-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDRA L. ELLIS, MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-09",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "248-353-2600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "SE070800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104077793",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Seterra Mahdi Nycole Sanders
• Gaganjot Sandhu, MD
• Ravinder Sandhu
• Sandra Brown M.D.,P.C.
• Sandra L Ellis MD PLLC
• Sandra S Lerner DO PLLC
• Margaret Sands-Goldstein
• Sangeeta Grewal
• Sankofa Healthcare Services
• Shanthiya Sanmugathas, M.D.

• Internal Medicine Physician in Southfield, MI
• Providers in Southfield, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.