Healthcare Provider Details

I. General information

NPI: 1669508917
Provider Name (Legal Business Name): HEALTH ONE MEDICAL CENTER, EASTPOINTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21501 KELLY RD
EASTPOINTE MI
48021-3213
US

IV. Provider business mailing address

21501 KELLY RD
EASTPOINTE MI
48021-3213
US

V. Phone/Fax

Practice location:
  • Phone: 586-776-4185
  • Fax: 586-776-5132
Mailing address:
  • Phone: 586-776-4185
  • Fax: 586-776-5132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301065258
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301065258
License Number StateMI

VIII. Authorized Official

Name: DR. SATISH R MEHTA
Title or Position: PRESIDENT
Credential: MD
Phone: 586-776-4185