Healthcare Provider Details

I. General information

NPI: 1205765989
Provider Name (Legal Business Name): UPPER GREAT LAKES FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MACINNES DR
HOUGHTON MI
49931-1144
US

IV. Provider business mailing address

600 MACINNES DR
HOUGHTON MI
49931-1144
US

V. Phone/Fax

Practice location:
  • Phone: 906-483-1818
  • Fax: 906-483-1811
Mailing address:
  • Phone: 906-483-1818
  • Fax: 906-483-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TREVOR HODGES
Title or Position: CEO
Credential:
Phone: 906-483-1846