Healthcare Provider Details

I. General information

NPI: 1548753783
Provider Name (Legal Business Name): COUNTY OF MUSKEGON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 E APPLE AVE
MUSKEGON MI
49442-3466
US

IV. Provider business mailing address

376 E APPLE AVE
MUSKEGON MI
49442-3466
US

V. Phone/Fax

Practice location:
  • Phone: 231-724-3665
  • Fax:
Mailing address:
  • Phone: 231-724-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDY KATHLEEN CARLSON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 231-724-1174