Eastes and Khanukov MD PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301048104 Issued in MI

Legal business name

EASTES AND KHANUKOV MD PC

Practice address

15500 19 Mile Rd
Suite 360
Clinton TWP, MI 48038-6330

Phone

(586) 263-9999

Fax

(586) 263-0581

NPI assigned

Sep 20, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bryan K Eastes, M.D.

Title

President

Phone

(586) 263-9999

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eugeniya Khanukov, MD

  • Internal Medicine Physician
  • Clinton Township, MI
  • NPI 1326056946
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249948800000",
    "number": "1902092273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15500 19 MILE RD",
            "address_2": "SUITE 360",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480386330",
            "telephone_number": "586-263-9999",
            "fax_number": "586-263-0581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15500 19 MILE RD",
            "address_2": "SUITE 360",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480386330",
            "telephone_number": "586-263-9999",
            "fax_number": "586-263-0581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTES AND KHANUKOV MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-20",
        "last_updated": "2009-08-11",
        "status": "A",
        "authorized_official_last_name": "EASTES",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "586-263-9999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301048104",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301052968",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104223612",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104223588",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "110E011460",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Lisa Elias

• Internal Medicine Physician in Clinton TWP, MI
• Providers in Clinton TWP, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.