Provider Demographics
NPI:1710560339
Name:SLATE, ERIC STEVEN
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:STEVEN
Last Name:SLATE
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 1:944 LINCOLN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1756
Mailing Address - Country:US
Mailing Address - Phone:734-318-5809
Mailing Address - Fax:
Practice Address - Street 1:944 LINCOLN AVE APT 1
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1756
Practice Address - Country:US
Practice Address - Phone:734-318-5809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-02
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
MI146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No175T00000XOther Service ProvidersPeer Specialist