Healthcare Provider Details

I. General information

NPI: 1538195722
Provider Name (Legal Business Name): EUCLID MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 EASTMAN AVE
MIDLAND MI
48640-2610
US

IV. Provider business mailing address

4615 EASTMAN AVE
MIDLAND MI
48640-2610
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-7110
  • Fax: 989-631-7210
Mailing address:
  • Phone: 989-631-7110
  • Fax: 989-892-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM E BERNER
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 989-892-7722