Eastborn Clinic PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5601005284 Issued in MI

Legal business name

EASTBORN CLINIC PLLC

Practice address

7526 Wyoming St
Ste# 2
Dearborn, MI 48126-1690

Phone

(313) 834-4444

NPI assigned

Jan 18, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Amin S Huballah, PA-CNPI 1912169343

Title

Physician Assistant

Phone

(313) 834-4444

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

Locations

Practitioners 2

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

• Amin Huballah, PA-C

  • Medical Physician Assistant
  • Dearborn, MI
  • NPI 1912169343
  Medicare reassignment Authorized official
• Farid Faraj Zayed, M.D.

  • Cardiovascular Disease Physician
  • Alma, MI
  • NPI 1417913690

  Internal Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1358467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398816000000",
    "number": "1578801080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7526 WYOMING ST",
            "address_2": "SUITE NUMBER 2",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481261690",
            "telephone_number": "313-834-4444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7526 WYOMING ST",
            "address_2": "STE# 2",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481261690",
            "telephone_number": "313-834-4444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTBORN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-18",
        "last_updated": "2014-04-30",
        "status": "A",
        "authorized_official_last_name": "HUBALLAH",
        "authorized_official_first_name": "AMIN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "313-834-4444",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5601005284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• 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 Apr 30, 2014; 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.