| Evo Body Image, Llc | |
|
950 E Maple Rd Ste L10 Birmingham MI 48009-6482 | |
| (248) 595-2363 | |
| Not Available |
| Full Name | Evo Body Image, Llc |
|---|---|
| Speciality | Dietitian, Registered |
| Location | 950 E Maple Rd Ste L10, Birmingham, Michigan |
| Authorized Official Name and Position | Sidra S Elia (ORGANIZER) |
| Authorized Official Contact | 2485952363 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evo Body Image, Llc 6642 Leytonstone Blvd West Bloomfield MI 48322-1200 Ph: () - | Evo Body Image, Llc 950 E Maple Rd Ste L10 Birmingham MI 48009-6482 Ph: (248) 595-2363 |
| NPI Number | 1821768649 |
|---|---|
| Provider Enumeration Date | 09/14/2021 |
| Last Update Date | 09/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821768649 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 133V00000X | Dietitian, Registered | (* (Not Available)) | Primary |
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