Provider Demographics
NPI:1730149451
Name:GARCIA, EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:GARCIA
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 1:5401 CRISPIN WAY RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3403
Mailing Address - Country:US
Mailing Address - Phone:734-459-7444
Mailing Address - Fax:734-459-7755
Practice Address - Street 1:15120 MICHIGAN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2916
Practice Address - Country:US
Practice Address - Phone:313-624-8417
Practice Address - Fax:313-357-7074
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEG031436207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI264294910OtherTAX ID #
MI4585710Medicaid
MI264294910OtherTAX ID #
MIMI1658Medicare PIN