Healthcare Provider Details

I. General information

NPI: 1255505723
Provider Name (Legal Business Name): EDDIE F EL-YUSSIF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35455 GARFIELD RD STE 100
CLINTON TOWNSHIP MI
48035-2500
US

IV. Provider business mailing address

35455 GARFIELD RD STE 100
CLINTON TOWNSHIP MI
48035-2500
US

V. Phone/Fax

Practice location:
  • Phone: 586-600-5633
  • Fax: 586-600-5634
Mailing address:
  • Phone: 586-600-5633
  • Fax: 586-600-5634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number0102202203
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number5101015546
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: