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Individual

CHARLES EASTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1501 W CHISHOLM ST, ALPENA, MI 49707-1401
(989) 340-1211
(989) 340-1214
Mailing address
PO BOX 6514, TRAVERSE CITY, MI 49696-6514
(231) 922-9270
(231) 922-9271

Taxonomy

Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
CE043624
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
110190089
RR MEDICARE #
MI
01
2900400781
BCBSM INDIVIDUAL #
MI
05
4113460
MI
01
CE043624
STATE LICENSE
MI
Enumeration date
08/24/2005
Last updated
07/30/2013
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