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General NPI Number Information
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NPI Number | 1013095173
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Entity Type | Organization
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Legal Business Name | LAKE HURON OB GYN PLLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 1005 S VAN DYKE RD
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City | BAD AXE
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State | MI
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Zip | 48413-9614
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Country | US
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Telephone | 989-269-3923
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Fax | 989-269-3983
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Provider Business Mailing Address
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Address Line | 1005 S VAN DYKE RD
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City | BAD AXE
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State | MI
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Zip | 48413-9614
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Country | US
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Telephone | 989-269-3923
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Fax | 989-269-3983
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Authorized Official
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Title or Position | OWNER
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Name | DR. NANCY BISCHER MACCHIARELLA
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Credential | D.O.
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Telephone | 989-269-3923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | NK013377
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License Number State | MI
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