Healthcare Provider Details

I. General information

NPI: 1689717811
Provider Name (Legal Business Name): MICHAEL PATRICK POIRIER MA, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 NAOMI ST
PLAINWELL MI
49080-1222
US

IV. Provider business mailing address

1279 103RD AVE
PLAINWELL MI
49080-1912
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-0781
  • Fax: 269-685-0893
Mailing address:
  • Phone: 269-685-5614
  • Fax: 269-685-0893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: