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General NPI Number Information
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NPI Number | 1477621050
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Entity Type | Organization
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Legal Business Name | EVERINGHAM CLINIC PC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 12100 HURON RIVER DRIVE
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City | ROMULUS
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State | MI
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Zip | 48174-1119
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Country | US
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Telephone | 734-941-1070
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Fax | 734-941-1763
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Provider Business Mailing Address
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Address Line | 12100 HURON RIVER DRIVE
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City | ROMULUS
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State | MI
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Zip | 48174-1119
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Country | US
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Telephone | 734-941-1070
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Fax | 734-941-1763
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAIG J EVERINGHAM
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Credential | DO
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Telephone | 734-941-1070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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