# EASTLAKE MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821267832
- **Authorized official:** MRS. BIANCA FELICIA DOOLEY (PRESIDENT CEO)
- **Authorized official phone:** (248) 747-3425

## Contact information

- **Practice address:** 646 CHENE ST, DETROIT, MI 48207-3979
- **Practice address phone:** (248) 747-3425
- **Mailing address:** 17520 W 12 MILE RD STE 116, SOUTHFIELD, MI 48076-1907
- **Mailing address phone:** (248) 443-6711

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/23/2008
- **Last updated:** 02/23/2008