Healthcare Provider Details

I. General information

NPI: 1871677955
Provider Name (Legal Business Name): SENIOR MEDICAL CORP. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3944 S BRENLOR DR
HESPERIA MI
49421-9585
US

IV. Provider business mailing address

6087 E FILMORE RD
WALKERVILLE MI
49459-9344
US

V. Phone/Fax

Practice location:
  • Phone: 231-854-2999
  • Fax: 231-854-2998
Mailing address:
  • Phone: 231-854-7655
  • Fax: 231-854-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberRT007455
License Number StateMI

VIII. Authorized Official

Name: DR. RAYMOND D TRACY
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 231-854-2999