Organization
EASTSIDE PODIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HATIM TAHIR BURHANI DPM (OWNER)
(313) 884-7566
Entity
Organization
Contact information
Practice address
24025 GREATER MACK, SUITE 101, SAINT CLAIR SHORES, MI 48080
(313) 884-7566
(313) 884-3140
Mailing address
24025 GREATER MACK, SUITE 101, ST. CLAIR SHORES, MI 48080-4311
(313) 884-7566
(313) 884-3140
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901002021
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4476009
—
MI
Enumeration date
01/04/2007
Last updated
05/22/2018
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