Healthcare Provider Details

I. General information

NPI: 1649650185
Provider Name (Legal Business Name): PHILLIP ESKANDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2015
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15855 19 MILE RD
CLINTON TOWNSHIP MI
48038-3504
US

IV. Provider business mailing address

9915 SAILOR CT
PORTAGE MI
49002-8254
US

V. Phone/Fax

Practice location:
  • Phone: 269-290-2298
  • Fax:
Mailing address:
  • Phone: 269-290-2298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number02005513A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101021944
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: