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NPI Code Detail

MEDICARE: MCLAREN CENTRAL MICHIGAN

MEDICARE: MCLAREN CENTRAL MICHIGAN
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1710235775
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCLAREN CENTRAL MICHIGAN
Provider Business Mailing Address
First Line : 1221 SOUTH DR
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-3257
Country : US
Telephone Number : 800-671-1453
Fax Number :
Provider Business Practice Location Address
First Line : 1221 SOUTH DR
Second Line :
City : MOUNT PLEASANT
State : MI
Zip : 48858-3257
Country : US
Telephone Number : 989-772-6700
Fax Number :
Authorized Official
Title or Position : VP/CFO
Name : TARA SOULES
Credential :
Telephone Number : 989-772-6720
Provider Enumeration Date : 08/23/2012
Last Update Date : 05/01/2020

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Directions to “MCLAREN CENTRAL MICHIGAN ” Practice Location

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