| Doctor Name: | DR. RICHARD IRA ELLENBOGEN |
| NPI Number: | 1093804619 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 5101006200 |
| Business Practice Address: | 4000 Highland Road #120 Waterford, MI - 48328 |
| Business Phone Number: | 2486822109 |
| Business Fax Number: | 2486824769 |
| Mailing Address: | 4000 Highland Road, #120 WATERFORD |
| State: | MI |
| Postal Code: | 48328 |
| Phone Number: | 2486822109 |
| Fax Number: | 2486824769 |
| NPI Enumeration Date: | 10/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 5101006200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |