Provider Demographics
NPI:1720517444
Name:TINDAL, ELIZABETH WILSON (MD MPH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WILSON
Last Name:TINDAL
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY STE 460
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1265
Mailing Address - Country:US
Mailing Address - Phone:248-662-4272
Mailing Address - Fax:248-662-3020
Practice Address - Street 1:26850 PROVIDENCE PKWY STE 460
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1265
Practice Address - Country:US
Practice Address - Phone:248-662-4272
Practice Address - Fax:248-662-3020
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-06
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY60331227208600000X
MI4301514696208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty