Healthcare Provider Details

I. General information

NPI: 1639108780
Provider Name (Legal Business Name): MCLAREN PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 E MILLER RD
FAIRVIEW MI
48621-8731
US

IV. Provider business mailing address

1900 COLUMBUS AVE ATTN: MCLAREN BAY REGION CEO
BAY CITY MI
48708-6831
US

V. Phone/Fax

Practice location:
  • Phone: 989-848-5484
  • Fax: 989-848-7139
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE C JACKS PORTER
Title or Position: VP/CFO
Credential:
Phone: 989-894-3838