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General NPI Number Information
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NPI Number | 1609951870
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Entity Type | Organization
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Legal Business Name | EASTSIDE CT
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1198 N BELSAY RD BLDG 2
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City | BURTON
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State | MI
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Zip | 48509-1669
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Country | US
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Telephone | 810-743-9130
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Fax | 810-743-3202
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Provider Business Mailing Address
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Address Line | 1198 N BELSAY RD BLDG 2
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City | BURTON
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State | MI
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Zip | 48509-1669
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Country | US
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Telephone | 810-743-9130
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Fax | 810-743-3203
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. PETER K. MCLEOD
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Credential | M.D.
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Telephone | 810-743-9130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State | MI
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