Healthcare Provider Details

I. General information

NPI: 1053819623
Provider Name (Legal Business Name): NORTHERN MICHIGAN HEART CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2079 US HIGHWAY 23 S
ALPENA MI
49707-4524
US

IV. Provider business mailing address

2079 US HIGHWAY 23 S
ALPENA MI
49707-4524
US

V. Phone/Fax

Practice location:
  • Phone: 989-340-2550
  • Fax: 989-340-2551
Mailing address:
  • Phone: 989-340-2550
  • Fax: 989-340-2551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301086730
License Number StateMI

VIII. Authorized Official

Name: JENNIFER MARIE MULHOLLAND
Title or Position: OFFICE MANAGER
Credential:
Phone: 989-340-2550