Healthcare Provider Details

I. General information

NPI: 1770108821
Provider Name (Legal Business Name): MATTHEW STEWART EASTHARDT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SOUTH BLVD E STE 310
ROCHESTER HILLS MI
48307-5624
US

IV. Provider business mailing address

3601 W 13 MILE RD
ROYAL OAK MI
48073-6712
US

V. Phone/Fax

Practice location:
  • Phone: 248-891-5256
  • Fax:
Mailing address:
  • Phone: 248-898-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4351046399
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301512670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: