Provider Demographics
NPI:1063466985
Name:HUG, EILEEN (DO)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:HUG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5353
Mailing Address - Country:US
Mailing Address - Phone:313-829-8434
Mailing Address - Fax:586-977-9932
Practice Address - Street 1:30205 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-6800
Practice Address - Country:US
Practice Address - Phone:586-759-7510
Practice Address - Fax:586-759-7791
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011517208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4478649Medicaid
H43554Medicare UPIN
MION65730Medicare ID - Type UnspecifiedCOMMON PROVIDER