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NPI Code Detail

MEDICARE: TRAVERSE BAY INTERNAL MEDICINE PC

MEDICARE: TRAVERSE BAY INTERNAL MEDICINE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1487023933
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRAVERSE BAY INTERNAL MEDICINE PC
Provider Business Mailing Address
First Line : 4977 SKYVIEW CT
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-6941
Country : US
Telephone Number : 231-947-0673
Fax Number : 801-740-2847
Provider Business Practice Location Address
First Line : 4977 SKYVIEW CT
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-6941
Country : US
Telephone Number : 231-947-0673
Fax Number : 801-740-2847
Authorized Official
Title or Position : CREDENTIALER
Name : MS. YVONNE E KAEHLER
Credential :
Telephone Number : 231-947-0673
Provider Enumeration Date : 09/15/2015
Last Update Date : 11/16/2015

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Directions to “TRAVERSE BAY INTERNAL MEDICINE PC ” Practice Location

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