Healthcare Provider Details

I. General information

NPI: 1598736407
Provider Name (Legal Business Name): ARTHUR BRADLEY EISENBREY III M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 W GRAND BLVD
DETROIT MI
48202-2608
US

IV. Provider business mailing address

1930 LENNON ST
GROSSE POINTE WOODS MI
48236-1615
US

V. Phone/Fax

Practice location:
  • Phone: 313-909-9654
  • Fax:
Mailing address:
  • Phone: 313-884-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301406793
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number4301406793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: