Evo Body Image, LLC

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

EVO BODY IMAGE, LLC

Practice address

950 E Maple Rd Ste L10
Birmingham, MI 48009-6482

Phone

(248) 595-2363

NPI assigned

Sep 14, 2021

Organization subpart

No

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

Authorized official

Name

Sidra S Elia, MD

Title

Organizer

Phone

(248) 595-2363

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Elia, RD, RDN

  • Registered Dietitian
  • Birmingham, MI
  • NPI 1558877613

  Dietitian, Registered

  NPD

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631577600000",
    "number": "1821768649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6642 LEYTONSTONE BLVD",
            "city": "WEST BLOOMFIELD",
            "state": "MI",
            "postal_code": "483221200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 E MAPLE RD STE L10",
            "city": "BIRMINGHAM",
            "state": "MI",
            "postal_code": "480096482",
            "telephone_number": "248-595-2363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVO BODY IMAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A",
        "authorized_official_last_name": "ELIA",
        "authorized_official_first_name": "SIDRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ORGANIZER",
        "authorized_official_telephone_number": "248-595-2363",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberlee Erison, DNP, APRN, FNP-C
• Robert Jeffrey Ernst, M.D.
• Eshan Physical Therapy PLLC
• Michelle Evangelista, LLMSW
• Eversafe LLC
• Executive Concierge Transportation LLC
• Exquisite Medical Solutions
• Stephen Dillon Fabick, ED.D.
• Facilicare Clinical Michigan PLLC
• Jonathan David Falk, PH.D.

• Registered Dietitian in Birmingham, MI
• Providers in Birmingham, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.