Individual
ALFONSO ACOSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7173 ILANAWAY DR, WEST BLOOMFIELD, MI 48324
(586) 929-0842
(248) 366-0065
Mailing address
PO BOX 250433, WEST BLOOMFIELD, MI 48325
(586) 929-0842
(248) 366-0065
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301064369
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1106335602
BC
MI
01
—
143552
GREAT LAKES
MI
05
—
4442468
—
MI
01
—
P00193884
PALMETTO GBA
—
Enumeration date
06/13/2005
Last updated
09/13/2007
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