Healthcare Provider Details

I. General information

NPI: 1649383837
Provider Name (Legal Business Name): ROGERS CITY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 N BRADLEY HWY
ROGERS CITY MI
49779-1508
US

IV. Provider business mailing address

573 N BRADLEY HWY
ROGERS CITY MI
49779-1508
US

V. Phone/Fax

Practice location:
  • Phone: 989-734-2171
  • Fax: 989-734-2312
Mailing address:
  • Phone: 989-734-2171
  • Fax: 989-734-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5010005938
License Number StateMI

VIII. Authorized Official

Name: MS. JENNIE MARIE KLINGSHIRN
Title or Position: PRACTICE MANAGER
Credential: MSN
Phone: 989-734-2171