Healthcare Provider Details

I. General information

NPI: 1245445972
Provider Name (Legal Business Name): PHYSICIAN HEALTHCARE NETWORK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 MILITARY ST BLDG 2
PORT HURON MI
48060-6692
US

IV. Provider business mailing address

3050 COMMERCE DR
FORT GRATIOT MI
48059-3819
US

V. Phone/Fax

Practice location:
  • Phone: 810-984-5700
  • Fax: 810-984-1886
Mailing address:
  • Phone: 810-385-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateMI

VIII. Authorized Official

Name: MIMMA CUSUMANO
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 810-385-8081