Healthcare Provider Details

I. General information

NPI: 1316995145
Provider Name (Legal Business Name): EILEEN M. POKRIEFKA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35111 DODGE PARK RD
STERLING HEIGHTS MI
48312-3922
US

IV. Provider business mailing address

401 S BALLENGER HWY
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 586-978-8010
  • Fax: 586-978-9075
Mailing address:
  • Phone: 810-342-1000
  • Fax: 810-342-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101010320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: