Healthcare Provider Details

I. General information

NPI: 1306866215
Provider Name (Legal Business Name): CENTRAL MICHIGAN FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 EAST MAIN STREET
FARWELL MI
48622
US

IV. Provider business mailing address

522 EAST MAIN STREET
FARWELL MI
48622
US

V. Phone/Fax

Practice location:
  • Phone: 989-588-6153
  • Fax: 989-588-6194
Mailing address:
  • Phone: 989-588-6153
  • Fax: 989-588-6194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014871
License Number StateMI

VIII. Authorized Official

Name: DR. BROCK W HORSLEY
Title or Position: OWNER
Credential: D.O
Phone: 989-588-6153