Provider Demographics
NPI:1801855762
Name:EINHORN, DEREK (MD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:EINHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39475 LEWIS DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2977
Mailing Address - Country:US
Mailing Address - Phone:248-374-0502
Mailing Address - Fax:248-374-0567
Practice Address - Street 1:39475 LEWIS DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2977
Practice Address - Country:US
Practice Address - Phone:248-374-0502
Practice Address - Fax:248-374-0567
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071970207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4640867Medicaid
MI1106346950OtherBCBSM
MIH73847Medicare UPIN
MI4640867Medicaid