Healthcare Provider Details

I. General information

NPI: 1598040701
Provider Name (Legal Business Name): FREYDOON M ESKANDARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27906 OLD COLONY ST
FARMINGTON HILLS MI
48334-3243
US

IV. Provider business mailing address

27906 OLD COLONY ST
FARMINGTON HILLS MI
48334-3243
US

V. Phone/Fax

Practice location:
  • Phone: 248-851-0134
  • Fax:
Mailing address:
  • Phone: 248-851-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301028588
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301028588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: