Healthcare Provider Details

I. General information

NPI: 1023006822
Provider Name (Legal Business Name): MEDICAL ARTS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2463 S M 30
WEST BRANCH MI
48661-9312
US

IV. Provider business mailing address

335 E HOUGHTON AVE
WEST BRANCH MI
48661-1127
US

V. Phone/Fax

Practice location:
  • Phone: 989-345-0807
  • Fax: 989-343-3107
Mailing address:
  • Phone: 989-345-0807
  • Fax: 989-343-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301030939
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301037610
License Number StateMI

VIII. Authorized Official

Name: MR. ROBERT A I MCGRAIL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 989-343-3107