Healthcare Provider Details

I. General information

NPI: 1922695303
Provider Name (Legal Business Name): JOHN EID SOLE MBR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

APPLEWOOND DR SHELBY
BROOKS MI
53912
US

IV. Provider business mailing address

APPLEWOOND DR SHELBY
BROOKS MI
53912
US

V. Phone/Fax

Practice location:
  • Phone: 586-907-1092
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN EID
Title or Position: DIRECTOR
Credential:
Phone: 586-907-1092