| Organization Name: | ALFONSO ACOSTA MD PC |
| NPI Number: | 1184881971 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALFONSO ACOSTA (PRESIDENT) |
| Mailing Address: | 7173 Ilanaway Dr W Bloomfield |
| State: | MI US |
| Postal Code: | 483242493 |
| Phone Number: | 5869290842 |
| Fax Number: | 2483660065 |
| NPI Enumeration Date: | 05/20/2008 |
| NPI Last Update Date: | 05/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4301064369 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |