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1548253545

NPI Code Detail

MEDICARE: CHARLES EASTON M.D.

MEDICARE: CHARLES EASTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	CE043624	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110190089	OTHER	MI	RR MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2900400781	OTHER	MI	BCBSM INDIVIDUAL #
2	CE043624	OTHER	MI	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548253545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES EASTON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6514
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49696-6514
Country	:	US
Telephone Number	:	231-922-9270
Fax Number	:	231-922-9271

Provider Business Practice Location Address
First Line	:	1501 W CHISHOLM ST
Second Line	:
City	:	ALPENA
State	:	MI
Zip	:	49707-1401
Country	:	US
Telephone Number	:	989-340-1211
Fax Number	:	989-340-1214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/30/2013

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Directions to “ CHARLES EASTON M.D.” Practice Location

Language	Start Address	Practice Location

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