Healthcare Provider Details

I. General information

NPI: 1255058749
Provider Name (Legal Business Name): FOUNDATIONS HEALTH & PHYSICAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2022
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W US HIGHWAY 2
NORWAY MI
49870-1175
US

IV. Provider business mailing address

415 W US HIGHWAY 2
NORWAY MI
49870-1175
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-5800
  • Fax: 906-563-5809
Mailing address:
  • Phone: 906-563-5800
  • Fax: 906-563-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL E ZEVITZ
Title or Position: OWNER
Credential: MD
Phone: 906-563-5800