Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 65352 | MN |
NPI | 1053707760 |
---|---|
Provider Name | Michael Eric Eastman |
First Address | Bloomington, MN 55425-4516 |
Second Address | Saint Paul, MN 55107-1805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 10/06/2021 |