Organization
EASTSIDE ASSOCIATES, LLC
Active
Other names
Eastside Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT VENERI M.D. (MEDICAL DIRECTOR)
(586) 447-5112
Entity
Organization
Contact information
Practice address
28963 LITTLE MACK AVE, SUITE 103, ST CLAIR SHORES, MI 48081-3015
(586) 447-5110
(586) 774-6091
Mailing address
28963 LITTLE MACK AVE, SUITE 103, ST CLAIR SHORES, MI 48081-3015
(586) 447-5110
(586) 774-6091
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
506822
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40358
BLUE CROSS ID NUMBER
MI
Enumeration date
11/04/2005
Last updated
02/08/2017
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