Healthcare Provider Details

I. General information

NPI: 1194981415
Provider Name (Legal Business Name): RICHARD P. PAYEA, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 TAWAS BEACH RD
EAST TAWAS MI
48730-9346
US

IV. Provider business mailing address

1195 TAWAS BEACH RD
EAST TAWAS MI
48730-9346
US

V. Phone/Fax

Practice location:
  • Phone: 989-362-2141
  • Fax: 989-362-7740
Mailing address:
  • Phone: 989-362-2141
  • Fax: 989-362-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301047848
License Number StateMI

VIII. Authorized Official

Name: DR. RICHARD P PAYEA
Title or Position: CEO
Credential: MD
Phone: 989-362-2141