NPIMap

Organization Active NPI

Eastes and Khanukov MD PC

  • Internal Medicine Physician
  • Clinton TWP, MI
National Provider Identifier
1902092273
Registry record updated Aug 11, 2009
On this page

Key facts

NPPES NPI Registry
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
Last updated
Aug 11, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2009

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.NPI 1336157866
Title
President
Phone
(586) 263-9999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 4301048104 MI Primary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X 4301052968 MI

Addresses

Primary practice location

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

Mailing address

15500 19 Mile Rd
Suite 360
Clinton TWP, MI 48038-6330
Phone (586) 263-9999

National Provider Directory

National Provider Directory

Locations

43900 Garfield Rd
Ste 210
Clinton Township, MI 48038
Phone (586) 263-9999

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clinton TWP, MI

Sources for this page

  • 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.