Eastlake Medical Center

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

EASTLAKE MEDICAL CENTER

Practice address

646 Chene St
Detroit, MI 48207-3979

Phone

(248) 747-3425

NPI assigned

Feb 23, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Bianca Felicia Dooley

Title

President Ceo

Phone

(248) 747-3425

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Johnny Ray Trotter II, M.D.

  • Surgery Physician
  • Southfield, MI
  • NPI 1548441058
  NPD (past)

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

{
    "created_epoch": "1203724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203724800000",
    "number": "1821267832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17520 W 12 MILE RD STE 116",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480761907",
            "telephone_number": "248-443-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "646 CHENE ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482073979",
            "telephone_number": "248-747-3425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTLAKE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-23",
        "last_updated": "2008-02-23",
        "status": "A",
        "authorized_official_last_name": "DOOLEY",
        "authorized_official_first_name": "BIANCA",
        "authorized_official_middle_name": "FELICIA",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "248-747-3425",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haley East
• Eastbrooke Medical Center
• Elizabeth Idell Easter
• Janita Kalaya Easter, LMSW
• Daja Janay Easterly
• Eastland Family Dentistry
• Kishana Eastmon
• Marlen Thershia Easton, CADCM
• Matthew Easton
• Eastpointe Radiologists, P.C. (Grosse Pointe Physicians Xray Center, PC)

• General Practice Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.