Healthcare Provider Details

I. General information

NPI: 1609966670
Provider Name (Legal Business Name): EASTPOINTE FAMILY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24901 KELLY RD
EASTPOINTE MI
48021-1367
US

IV. Provider business mailing address

24901 KELLY RD
EASTPOINTE MI
48021-1367
US

V. Phone/Fax

Practice location:
  • Phone: 586-772-9055
  • Fax: 586-772-0543
Mailing address:
  • Phone: 586-772-9055
  • Fax: 586-772-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number5101010763
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: MR. HARDIK M SHAH
Title or Position: PRESIDENT/ OWNER
Credential: D.O.
Phone: 586-772-9055