Organization
EASTLAKE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BIANCA FELICIA DOOLEY (PRESIDENT CEO)
(248) 747-3425
Entity
Organization
Contact information
Practice address
646 CHENE ST, DETROIT, MI 48207-3979
(248) 747-3425
Mailing address
17520 W 12 MILE RD STE 116, SOUTHFIELD, MI 48076-1907
(248) 443-6711
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
02/23/2008
Last updated
02/23/2008
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