Healthcare Provider Details

I. General information

NPI: 1609552173
Provider Name (Legal Business Name): ELEVATE MEDICAL SPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 E MITCHELL RD STE A
PETOSKEY MI
49770-6601
US

IV. Provider business mailing address

2230 E MITCHELL RD STE A
PETOSKEY MI
49770-6601
US

V. Phone/Fax

Practice location:
  • Phone: 231-622-8103
  • Fax:
Mailing address:
  • Phone: 231-622-8103
  • Fax: 949-695-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARTHA JEAN GOETZ
Title or Position: OWNER
Credential: FNP
Phone: 231-622-8103