Healthcare Provider Details

I. General information

NPI: 1073431763
Provider Name (Legal Business Name): MICHIGAN INSTITUTE OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 FORTUNE BLVD
SAGINAW MI
48603-2287
US

IV. Provider business mailing address

3925 FORTUNE BLVD
SAGINAW MI
48603-2287
US

V. Phone/Fax

Practice location:
  • Phone: 989-341-5078
  • Fax:
Mailing address:
  • Phone: 989-341-5078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID STOCKMAN
Title or Position: OWNER
Credential: MD
Phone: 989-341-5078