Healthcare Provider Details

I. General information

NPI: 1073621835
Provider Name (Legal Business Name): EASTPOINTE INTERNISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28295 SCHOENHERR RD STE C
WARREN MI
48088-4300
US

IV. Provider business mailing address

28295 SCHOENHERR RD STE C
WARREN MI
48088-4300
US

V. Phone/Fax

Practice location:
  • Phone: 586-573-6669
  • Fax: 586-573-6667
Mailing address:
  • Phone: 586-573-6669
  • Fax: 586-573-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301407063
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301047282
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301049997
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003884
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003978
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601003403
License Number StateMI

VIII. Authorized Official

Name: DR. DOMINIC A CUSUMANO III
Title or Position: OWNER
Credential: MD
Phone: 586-573-6669