Healthcare Provider Details

I. General information

NPI: 1447277496
Provider Name (Legal Business Name): HURON MEDICAL CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PINE GROVE AVE
PORT HURON MI
48060-3511
US

IV. Provider business mailing address

1231 PINE GROVE AVE SUITE 2F
PORT HURON MI
48060-3500
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-5200
  • Fax: 810-982-9776
Mailing address:
  • Phone: 810-982-5200
  • Fax: 810-982-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301051703
License Number StateMI

VIII. Authorized Official

Name: MRS. THERESA LYNN STILES
Title or Position: OFFICE MANAGER/BILLER
Credential:
Phone: 810-982-5200