Organization
EASTES AND KHANUKOV MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN K EASTES M.D. (PRESIDENT)
(586) 263-9999
Entity
Organization
Contact information
Practice address
15500 19 MILE RD, SUITE 360, CLINTON TWP, MI 48038-6330
(586) 263-9999
(586) 263-0581
Mailing address
15500 19 MILE RD, SUITE 360, CLINTON TWP, MI 48038-6330
(586) 263-9999
(586) 263-0581
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301048104
MI
207R00000X
Internal Medicine Physician
4301052968
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104223588
—
MI
05
—
104223612
—
MI
01
—
110E011460
BCBS
MI
Enumeration date
09/20/2007
Last updated
08/11/2009
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