Provider Demographics
NPI:1073621835
Name:EASTPOINTE INTERNISTS, P.C.
Entity Type:Organization
Organization Name:EASTPOINTE INTERNISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:CUSUMANO
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:586-573-6669
Mailing Address - Street 1:28295 SCHOENHERR RD
Mailing Address - Street 2:STE C
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4300
Mailing Address - Country:US
Mailing Address - Phone:586-573-6669
Mailing Address - Fax:586-573-6667
Practice Address - Street 1:28295 SCHOENHERR RD
Practice Address - Street 2:STE C
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4300
Practice Address - Country:US
Practice Address - Phone:586-573-6669
Practice Address - Fax:586-573-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407063207R00000X
MI4301047282208600000X
MI4301049997208600000X
MI5601003884363A00000X
MI5601003978363A00000X
MI5601003403363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06364Medicare PIN