Organization
ALFONSO ACOSTA MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALFONSO ACOSTA MD (PRESIDENT)
(586) 929-0842
Entity
Organization
Contact information
Practice address
7173 ILANAWAY DR, W BLOOMFIELD, MI 48324-2493
(586) 929-0842
(248) 366-0065
Mailing address
PO BOX 250433, W BLOOMFIELD, MI 48325-0433
(586) 929-0842
(248) 366-0065
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301064369
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103522994
—
MI
01
—
1106335602
BCBSM
—
01
—
P00193884
RAILROAD MEDICARE
—
Enumeration date
05/20/2008
Last updated
05/20/2008
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