Healthcare Provider Details

I. General information

NPI: 1407957988
Provider Name (Legal Business Name): PRINCE J EUBANKS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17330 NORTHLAND PARK CT STE 100
SOUTHFIELD MI
48075-4319
US

IV. Provider business mailing address

19785 W 12 MILE RD #268
SOUTHFIELD MI
48076-2543
US

V. Phone/Fax

Practice location:
  • Phone: 248-569-1045
  • Fax: 248-569-1058
Mailing address:
  • Phone: 313-273-2330
  • Fax: 313-273-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: PRINCE EUBANKS
Title or Position: OWNER
Credential:
Phone: 313-273-2330