Eastborn Medical Group PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301089499 Issued in MI

Legal business name

EASTBORN MEDICAL GROUP PC

Practice address

15044 Michigan Ave
Dearborn, MI 48126-2914

Phone

(313) 460-9965

NPI assigned

Oct 19, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Assem Elfakih, MDNPI 1881899946

Title

Owner

Phone

(313) 460-9965

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Assem A Elfakih, M.D.

  • Internal Medicine Physician
  • Dearborn, MI
  • NPI 1881899946
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1306397989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15044 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262914",
            "telephone_number": "313-460-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15044 MICHIGAN AVE",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481262914",
            "telephone_number": "313-460-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTBORN MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "ELFAKIH",
        "authorized_official_first_name": "ASSEM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-460-9965",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301089499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Dearborn Medical Clinic PC
• East Dearborn Urgent Care PC
• East Village Medical Center PC
• East Village Pharmay Inc
• Eastborn Clinic PLLC
• Eastborn RX Pharmacy LLC
• Easterseals Morc Health Care, Inc.
• Michelle Renee Eastman
• Hillary Easton
• Eastwood Community Clinics

• Internal Medicine Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.