Healthcare Provider Details

I. General information

NPI: 1639351984
Provider Name (Legal Business Name): ELK RAPIDS MEDICAL CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 BRIDGE ST POST OFFICE BOX 119
ELK RAPIDS MI
49629-9701
US

IV. Provider business mailing address

516 BRIDGE ST
ELK RAPIDS MI
49629-9701
US

V. Phone/Fax

Practice location:
  • Phone: 231-264-0700
  • Fax:
Mailing address:
  • Phone: 231-264-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAK1664069
License Number StateMI

VIII. Authorized Official

Name: DR. ANN K KUENKER
Title or Position: PRESIDENT/OWNER
Credential: D.O.
Phone: 231-264-0700