Healthcare Provider Details

I. General information

NPI: 1578530705
Provider Name (Legal Business Name): MICHAEL E EASTMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DOCTORS CT
JOHNSON CREEK WI
53038-9451
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 920-699-3500
  • Fax: 920-699-2100
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number36921
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: