Provider Demographics
NPI:1073534392
Name:DUBOIS MEDICAL ENTERPRISES PC
Entity Type:Organization
Organization Name:DUBOIS MEDICAL ENTERPRISES PC
Other - Org Name:EASTSIDE FAMILY MEDICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-972-2710
Mailing Address - Street 1:8540 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49346-9764
Mailing Address - Country:US
Mailing Address - Phone:231-972-2710
Mailing Address - Fax:231-972-2712
Practice Address - Street 1:8540 105TH AVE
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:MI
Practice Address - Zip Code:49346-9764
Practice Address - Country:US
Practice Address - Phone:231-972-2710
Practice Address - Fax:231-972-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E46007OtherBCBS
MI233869Medicare PIN
MI0E46007Medicare PIN