Healthcare Provider Details

I. General information

NPI: 1518119031
Provider Name (Legal Business Name): OWOSSO MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 10/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH PARK DR
OWOSSO MI
48867-1291
US

IV. Provider business mailing address

200 HEALTH PARK DR
OWOSSO MI
48867-1291
US

V. Phone/Fax

Practice location:
  • Phone: 989-723-8666
  • Fax:
Mailing address:
  • Phone: 989-723-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERESA L WIEGEL
Title or Position: ACCOUNTING/GENERAL MANAGER
Credential:
Phone: 989-723-8666