Healthcare Provider Details

I. General information

NPI: 1932249984
Provider Name (Legal Business Name): CEDAR HILL MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 US HIGHWAY 2/41 SUITE 201
BARK RIVER MI
49807-9661
US

IV. Provider business mailing address

2845 US HIGHWAY 2/41 SUITE 201
BARK RIVER MI
49807-9661
US

V. Phone/Fax

Practice location:
  • Phone: 906-466-2000
  • Fax: 906-466-2027
Mailing address:
  • Phone: 906-466-2000
  • Fax: 906-466-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301076738
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. THEODORE MATTHEW OSWALD
Title or Position: DIRECT OWNER
Credential: M.D.
Phone: 906-466-2000