Provider Demographics
NPI:1841391323
Name:EUBANKS, PRINCE JEROME (MD)
Entity type:Individual
Prefix:
First Name:PRINCE
Middle Name:JEROME
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19785 W 12 MILE RD STE 268
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2584
Mailing Address - Country:US
Mailing Address - Phone:248-569-1045
Mailing Address - Fax:248-569-1058
Practice Address - Street 1:17330 NORTHLAND PARK CT STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4319
Practice Address - Country:US
Practice Address - Phone:248-569-1045
Practice Address - Fax:248-569-1058
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2025-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301044813207RA0401X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine