Healthcare Provider Details

I. General information

NPI: 1548253545
Provider Name (Legal Business Name): CHARLES EASTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CHISHOLM ST
ALPENA MI
49707-1401
US

IV. Provider business mailing address

PO BOX 6514
TRAVERSE CITY MI
49696-6514
US

V. Phone/Fax

Practice location:
  • Phone: 989-340-1211
  • Fax: 989-340-1214
Mailing address:
  • Phone: 231-922-9270
  • Fax: 231-922-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberCE043624
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: