Healthcare Provider Details

I. General information

NPI: 1912087685
Provider Name (Legal Business Name): MANITOU MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 W OTTAWA AVE
EMPIRE MI
49630-9618
US

IV. Provider business mailing address

9975 W OTTAWA AVE
EMPIRE MI
49630-9618
US

V. Phone/Fax

Practice location:
  • Phone: 231-326-2300
  • Fax: 231-326-2302
Mailing address:
  • Phone: 231-326-2300
  • Fax: 231-326-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301048430
License Number StateMI

VIII. Authorized Official

Name: DR. DOUGLAS COLES
Title or Position: OWNER
Credential: MD
Phone: 231-352-7103