Healthcare Provider Details

I. General information

NPI: 1174810238
Provider Name (Legal Business Name): MICHIGAN EMERGENCY PHYSICIANS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N MCEWAN ST
CLARE MI
48617-1440
US

IV. Provider business mailing address

75 REMIT DR # 1122
CHICAGO IL
60675-1122
US

V. Phone/Fax

Practice location:
  • Phone: 989-802-5000
  • Fax: 989-802-8800
Mailing address:
  • Phone: 866-916-5259
  • Fax: 231-922-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DERIK K KING
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 239-939-1717