Healthcare Provider Details

I. General information

NPI: 1700243151
Provider Name (Legal Business Name): PATRICK G EILERS LLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2016
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44070 W 12 MILE RD STE 200
NOVI MI
48377-2648
US

IV. Provider business mailing address

44070 W 12 MILE RD STE 200
NOVI MI
48377-2648
US

V. Phone/Fax

Practice location:
  • Phone: 248-773-8440
  • Fax:
Mailing address:
  • Phone: 248-773-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6301016564
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: