Healthcare Provider Details

I. General information

NPI: 1881754554
Provider Name (Legal Business Name): MCLAREN NORTHERN MICHIGAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CONNABLE AVE
PETOSKEY MI
49770-2212
US

IV. Provider business mailing address

416 CONNABLE AVE
PETOSKEY MI
49770-2212
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-7129
  • Fax:
Mailing address:
  • Phone: 231-487-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: STEVEN THOMPSON
Title or Position: VP/CFO
Credential:
Phone: 231-487-4094