Healthcare Provider Details

I. General information

NPI: 1750222956
Provider Name (Legal Business Name): NORTHERN MICHIGAN MUSCULOSKELETAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 CHARLEVOIX RD STE 104
PETOSKEY MI
49770-8421
US

IV. Provider business mailing address

110 TERRACE ST
CHARLEVOIX MI
49720-1733
US

V. Phone/Fax

Practice location:
  • Phone: 248-444-8683
  • Fax:
Mailing address:
  • Phone: 248-444-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER NEMES
Title or Position: MEMBER
Credential: DO
Phone: 248-444-8683