Provider Demographics
NPI:1811236151
Name:PROFESSIONAL HOME DOCTORS
Entity Type:Organization
Organization Name:PROFESSIONAL HOME DOCTORS
Other - Org Name:EASTBORN MEDICAL CLINCI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-779-2898
Mailing Address - Street 1:PO BOX 2227
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-2227
Mailing Address - Country:US
Mailing Address - Phone:313-779-2898
Mailing Address - Fax:
Practice Address - Street 1:7526 WYOMING ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1690
Practice Address - Country:US
Practice Address - Phone:313-834-4444
Practice Address - Fax:313-834-8888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL HOME DOCTIRS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty