| Doctor Name: | ANGELIQUE NIKKOL-TELYCENAS ELLISON |
| NPI Number: | 1154769214 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 5101020652 |
| Business Practice Address: | 5450 Fort St Trenton, MI - 481834601 |
| Business Phone Number: | 7346713297 |
| Business Fax Number: | |
| Mailing Address: | 2610 E Labo Rd, CARLETON |
| State: | MI |
| Postal Code: | 481179034 |
| Phone Number: | 7346520504 |
| Fax Number: | |
| NPI Enumeration Date: | 06/11/2013 |
| NPI Last Update Date: | 06/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 5101020652 |
| 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. |