Healthcare Provider Details

I. General information

NPI: 1538106026
Provider Name (Legal Business Name): MICHAEL J EADIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STODDARD RD
RICHMOND MI
48062-2505
US

IV. Provider business mailing address

400 STODDARD RD
RICHMOND MI
48062-2505
US

V. Phone/Fax

Practice location:
  • Phone: 810-392-2167
  • Fax: 810-392-2057
Mailing address:
  • Phone: 810-392-2167
  • Fax: 810-392-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number4301044474
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: