Healthcare Provider Details

I. General information

NPI: 1518020585
Provider Name (Legal Business Name): HPCN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N MICHIGAN AVE
SHELBY MI
49455-1028
US

IV. Provider business mailing address

218 N MICHIGAN AVE
SHELBY MI
49455-1028
US

V. Phone/Fax

Practice location:
  • Phone: 231-861-2187
  • Fax: 231-894-6248
Mailing address:
  • Phone: 231-861-2187
  • Fax: 231-894-6248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. COLLEEN B JOHNSON
Title or Position: PRACTICE EXECUTIVE
Credential: C.M.P.E.
Phone: 231-728-5910