Provider Demographics
NPI:1730116682
Name:DONOVAN, EILEEN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:MARIE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1863
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:18501 ROTUNDA DR STE 200
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3891
Practice Address - Country:US
Practice Address - Phone:313-996-1960
Practice Address - Fax:313-996-1965
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43040655852081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301065585OtherMEDICAL LICENSE, MI
MI4409463Medicaid
MI4409463Medicaid