East Dearborn Medical Clinic PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

4301069195 Issued in MI

Legal business name

EAST DEARBORN MEDICAL CLINIC PC

Practice address

14650 W Warren Ave
Ste 150
Dearborn, MI 48126-1799

Phone

(313) 581-0200

Fax

(313) 582-3300

NPI assigned

Oct 12, 2016

Last updated

Nov 1, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Abdul Mhanna

Title

Owner

Phone

(313) 581-0200

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, and the practitioner matching its NPPES authorized official.

• Adham Ahmad Sayed-Ali, M.D

  • Family Medicine Physician
  • Dearborn, MI
  • NPI 1689789992
  Medicare reassignment

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477958400000",
    "number": "1871043000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14650 W WARREN AVE",
            "address_2": "STE 150",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481261799",
            "telephone_number": "313-581-0200",
            "fax_number": "313-582-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14650 W WARREN AVE",
            "address_2": "STE 150",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481261799",
            "telephone_number": "313-581-0200",
            "fax_number": "313-582-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST DEARBORN MEDICAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-11-01",
        "status": "A",
        "authorized_official_last_name": "MHANNA",
        "authorized_official_first_name": "ABDUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-581-0200",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MI",
            "license": "4301069195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Anna Eapen, M.D.
• Ear Center Inc
• Andrew George Easow
• East Dearborn Dialysis LLC (East Dearborn Dialysis)
• East Dearborn Medical Center PC
• East Dearborn Urgent Care PC
• East Village Medical Center PC
• East Village Pharmay Inc (East Village Pharmacy)
• Eastborn Clinic PLLC
• Eastborn Medical Group PC

• Primary Care Clinic/Center in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Primary Care Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.