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General NPI Number Information
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NPI Number | 1831098391
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Entity Type | Organization
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Legal Business Name | EASTSIDE PODIATRY PLLC
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Dates
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Enumeration Date | 11/02/2026
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Last Update Date | 11/02/2026
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Provider Practice Location Address
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Address Line | 31046 UTICA RD
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City | FRASER
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State | MI
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Zip | 48026-2534
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Country | US
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Telephone | 586-368-3112
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Fax |
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Provider Business Mailing Address
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Address Line | 24025 GREATER MACK AVE STE 101
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-4311
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Country | US
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Telephone | 586-913-5199
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HATIM TAHIR BURHANI
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Credential |
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Telephone | 313-884-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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