Provider Demographics
NPI:1386673549
Name:EAST AREA FAMILY PHYSICIANS, P.C.
Entity Type:Organization
Organization Name:EAST AREA FAMILY PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:COSTEA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-294-9600
Mailing Address - Street 1:30695 LITTLE MACK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-1771
Mailing Address - Country:US
Mailing Address - Phone:586-294-9600
Mailing Address - Fax:586-294-7570
Practice Address - Street 1:30695 LITTLE MACK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-1771
Practice Address - Country:US
Practice Address - Phone:586-294-9600
Practice Address - Fax:586-294-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB049169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06466Medicare ID - Type Unspecified