Provider Demographics
NPI:1922383355
Name:EIDSATH, JAMIE (CPM)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:EIDSATH
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6193
Mailing Address - Country:US
Mailing Address - Phone:734-274-5325
Mailing Address - Fax:
Practice Address - Street 1:1545 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6193
Practice Address - Country:US
Practice Address - Phone:734-274-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife