MEDICARE: MICHIGAN MEDICAL PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	207X00000X	Orthopaedic Surgery Physician
3	208000000X	Pediatrics Physician
4	207RC0000X	Cardiovascular Disease Physician
5	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1598937716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHIGAN MEDICAL PC

Provider Business Mailing Address
First Line	:	4085 BURTON ST SE
Second Line	:	SUITE 200
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1003 N LAFAYETTE ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1168
Country	:	US
Telephone Number	:	616-754-3001
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	SCOTT HARRING
Credential	:
Telephone Number	:	616-974-4889

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	05/06/2008

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