Healthcare Provider Details

I. General information

NPI: 1477621050
Provider Name (Legal Business Name): EVERINGHAM CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12100 HURON RIVER DRIVE
ROMULUS MI
48174-1119
US

IV. Provider business mailing address

12100 HURON RIVER DRIVE
ROMULUS MI
48174-1119
US

V. Phone/Fax

Practice location:
  • Phone: 734-941-1070
  • Fax: 734-941-1763
Mailing address:
  • Phone: 734-941-1070
  • Fax: 734-941-1763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG J EVERINGHAM
Title or Position: PRESIDENT
Credential: DO
Phone: 734-941-1070