Healthcare Provider Details

I. General information

NPI: 1992231377
Provider Name (Legal Business Name): ECS NORTHERN MICHIGAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CONNABLE AVE
PETOSKEY MI
49770
US

IV. Provider business mailing address

PO BOX 30516 DEPT 4101
LANSING MI
48909-8016
US

V. Phone/Fax

Practice location:
  • Phone: 800-248-6777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY MUNGER
Title or Position: CFO
Credential:
Phone: 616-988-8225