Healthcare Provider Details

I. General information

NPI: 1720745003
Provider Name (Legal Business Name): HURON MEDICAL CENTER P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 ELECTRIC AVE
PORT HURON MI
48060-6590
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 810-824-4066
  • Fax:
Mailing address:
  • Phone: 810-982-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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