MEDICARE: MIKE ELDIRANI MD PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366077000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKE ELDIRANI MD PLC

Provider Business Mailing Address
First Line	:	30700 TELEGRAPH RD STE 3670
Second Line	:
City	:	BINGHAM FARMS
State	:	MI
Zip	:	48025-4568
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25325 FORD RD STE 200
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48128-1086
Country	:	US
Telephone Number	:	313-456-5050
Fax Number	:	313-914-5922

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	DIANA EL MASRI
Credential	:
Telephone Number	:	248-215-0048

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	04/10/2023

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