Organization
CENTER FOR ADVANCED INTERVENTIONAL SPINE TREATMENT PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN EASA MD (SOLE MEMBER)
(616) 796-6430
Entity
Organization
Contact information
Practice address
12662 RILEY ST STE 120, HOLLAND, MI 49424-8023
(616) 796-6430
(616) 786-4324
Mailing address
12662 RILEY ST STE 120, HOLLAND, MI 49424-8023
(616) 796-6430
(616) 786-4324
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
JE069312
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3441763
—
MI
Enumeration date
10/20/2009
Last updated
01/08/2010
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