Healthcare Provider Details

I. General information

NPI: 1417994468
Provider Name (Legal Business Name): MYMICHIGAN MEDICAL CENTER ALPENA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W CHISHOLM ST
ALPENA MI
49707
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-1401
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-7390
  • Fax: 989-356-8013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number040010
License Number StateMI

VIII. Authorized Official

Name: CHARLES H SHERWIN
Title or Position: PRESIDENT
Credential:
Phone: 989-356-7245