Basic Information
| Provider Information | |||||||||
| NPI: | 1720247299 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EADIE | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | RONALD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 N SQUIRREL RD | ||||||||
| Address2: | |||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483264002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164027806 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 GENESYS PARKWAY | ||||||||
| Address2: | GENESYS REGIONAL MEDICAL CENTER | ||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106065000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5101017658 | MI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.