Healthcare Provider Details

I. General information

NPI: 1083790026
Provider Name (Legal Business Name): SPRING STREET FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 N SPRING ST
GLADWIN MI
48624
US

IV. Provider business mailing address

801 JOE MANN BLVD STE P-6
MIDLAND MI
48642-8900
US

V. Phone/Fax

Practice location:
  • Phone: 989-426-5553
  • Fax:
Mailing address:
  • Phone: 989-791-2455
  • Fax: 989-791-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4704126534
License Number StateMI

VIII. Authorized Official

Name: JANET FLYNN
Title or Position: OWNER
Credential: NP
Phone: 989-426-5590