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General NPI Number Information
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NPI Number | 1841391323
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Entity Type | Individual
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Provider Name | PRINCE JEROME EUBANKS MD
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Gender | Male
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 17330 NORTHLAND PARK CT STE 100
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4319
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Country | US
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Telephone | 248-569-1045
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Fax | 248-569-1058
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Provider Business Mailing Address
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Address Line | 19785 W 12 MILE RD STE 268
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City | SOUTHFIELD
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State | MI
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Zip | 48076-2584
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Country | US
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Telephone | 248-569-1045
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Fax | 248-569-1058
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 4301044813
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 4301044813
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License Number State | MI
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