Healthcare Provider Details

I. General information

NPI: 1154337749
Provider Name (Legal Business Name): MICHIGAN HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4808 W VERNOR MICHIGAN HEALTH CENTER
DETROIT MI
48209
US

IV. Provider business mailing address

26400 W TWELVE MILE RD STE 160
SOUTHFIELD MI
48034
US

V. Phone/Fax

Practice location:
  • Phone: 313-843-2500
  • Fax: 248-356-3442
Mailing address:
  • Phone: 248-356-8567
  • Fax: 248-356-3442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberIN076343
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAE059188
License Number StateMI

VIII. Authorized Official

Name: AZHAR A ESHO
Title or Position: PRESIDENT
Credential: MD
Phone: 248-356-8567