Provider Demographics
NPI:1477599819
Name:EASTMAN, KIM J (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:J
Last Name:EASTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3565 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5335
Mailing Address - Country:US
Mailing Address - Phone:616-456-8515
Mailing Address - Fax:616-233-1108
Practice Address - Street 1:350 LAFAYETTE AVE SE
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4656
Practice Address - Country:US
Practice Address - Phone:616-456-8515
Practice Address - Fax:616-233-1108
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042588207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4188442Medicaid
MIM51600004Medicare PIN
MIA77021Medicare UPIN