Organization
EASTSIDE CT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER K. MCLEOD M.D. (SECRETARY)
(810) 743-9130
Entity
Organization
Contact information
Practice address
1198 N BELSAY RD BLDG 2, BURTON, MI 48509-1669
(810) 743-9130
(810) 743-3202
Mailing address
1198 N BELSAY RD BLDG 2, BURTON, MI 48509-1669
(810) 743-9130
(810) 743-3203
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3078222
HEALTH PLUS PROVIDER NO.
MI
01
—
O B5 6177
BCBS PROVIDER CODE
MI
Enumeration date
10/26/2006
Last updated
08/22/2020
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