Healthcare Provider Details

I. General information

NPI: 1306844055
Provider Name (Legal Business Name): ROBERT J EASTWAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 E SHERMAN BLVD
MUSKEGON MI
49444-1879
US

IV. Provider business mailing address

55 ARTHUR ST
MANISTEE MI
49660-1101
US

V. Phone/Fax

Practice location:
  • Phone: 231-672-3500
  • Fax: 231-672-6199
Mailing address:
  • Phone: 231-727-4444
  • Fax: 231-728-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number3400-2367
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101020800
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: