Provider Demographics
NPI:1609128925
Name:EASTER, MICHAEL B
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:EASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE BLDG B
Mailing Address - Street 2:SUITE 133
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2403
Mailing Address - Country:US
Mailing Address - Phone:510-553-8500
Mailing Address - Fax:510-553-8550
Practice Address - Street 1:7200 BANCROFT AVE BLDG B
Practice Address - Street 2:SUITE 133
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-553-8500
Practice Address - Fax:510-553-8550
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist