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General NPI Number Information
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NPI Number | 1285719286
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Entity Type | Organization
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Legal Business Name | EASTMAN & VEMPATI MD PC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 30795 23 MILE RD SUITE 202
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5720
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Country | US
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Telephone | 586-421-1740
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Fax | 586-421-1744
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Provider Business Mailing Address
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Address Line | 30795 23 MILE RD SUITE 202
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City | CHESTERFIELD
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State | MI
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Zip | 48047-5720
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Country | US
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Telephone | 586-421-1740
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Fax | 586-421-1744
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIANNE MCKINNON
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Credential |
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Telephone | 586-421-1740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | MI
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