Healthcare Provider Details

I. General information

NPI: 1497793863
Provider Name (Legal Business Name): MID-MICHIGAN FAMILY MEDICAL CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11615 HARTEL RD SUITE 108
GRAND LEDGE MI
48837-9165
US

IV. Provider business mailing address

11615 HARTEL RD SUITE 108
GRAND LEDGE MI
48837-9165
US

V. Phone/Fax

Practice location:
  • Phone: 517-627-3281
  • Fax: 517-627-8722
Mailing address:
  • Phone: 517-627-3281
  • Fax: 517-627-8722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301406591
License Number StateMI

VIII. Authorized Official

Name: MR. JOSEPH PAUL VAN ARK
Title or Position: PRESIDENT
Credential: MD
Phone: 517-627-3281