# ALFONSO ACOSTA MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184881971
- **Authorized official:** DR. ALFONSO ACOSTA MD (PRESIDENT)
- **Authorized official phone:** (586) 929-0842

## Contact information

- **Practice address:** 7173 ILANAWAY DR, W BLOOMFIELD, MI 48324-2493
- **Practice address phone:** (586) 929-0842
- **Practice address fax:** (248) 366-0065
- **Mailing address:** PO BOX 250433, W BLOOMFIELD, MI 48325-0433
- **Mailing address phone:** (586) 929-0842
- **Mailing address fax:** (248) 366-0065

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4301064369 | MI | Yes |

## Other

- **Enumeration date:** 05/20/2008
- **Last updated:** 05/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 103522994 | — | MI |
| 01 | — | 1106335602 | BCBSM | — |
| 01 | — | P00193884 | RAILROAD MEDICARE | — |