EASTSIDE ASSOCIATES, LLC; NPI #1407847676

Contact Information

EASTSIDE ASSOCIATES, LLC

28963 LITTLE MACK AVE
SUITE 103
SAINT CLAIR SHORES, MI 48081-3015

Phone: 586-447-5110
Fax: 586-774-6091
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Endoscopy	261QE0800X

Indicates primary specialty

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NPI Profile & details for EASTSIDE ASSOCIATES, LLC

NPI # 1407847676

LBN Legal business name EASTSIDE ASSOCIATES, LLC

Authorized official ROBERT VENERI - (MEDICAL DIRECTOR)

Entity Organization

Organization subpart ¹ No

Enumeration date 11/04/2005

Last updated 02/08/2017 - About 9 years ago

Identifiers

MI	License #	506822
MI	Other	40358	BLUE CROSS ID NUMBER

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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