Healthcare Provider Details

I. General information

NPI: 1801008735
Provider Name (Legal Business Name): MYMICHIGAN MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WELLNESS DR
MIDLAND MI
48670-0001
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-0001
US

V. Phone/Fax

Practice location:
  • Phone: 989-539-4096
  • Fax:
Mailing address:
  • Phone: 844-832-1956
  • Fax: 989-633-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCN083244
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH JAMES
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 989-701-4734