MEDICARE: DR. EILEEN MARIE DONOVAN MD

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	2081P0010X	Pediatric Rehabilitation Medicine Physician	4304065585	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301065585	OTHER	MI	MEDICAL LICENSE, MI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730116682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EILEEN MARIE DONOVAN MD

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:	947-522-1863
Fax Number	:	947-522-0307

Provider Business Practice Location Address
First Line	:	18501 ROTUNDA DR STE 200
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-3891
Country	:	US
Telephone Number	:	313-996-1960
Fax Number	:	313-996-1965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/22/2020

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