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General NPI Number Information
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NPI Number | 1043499353
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Entity Type | Organization
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Legal Business Name | NORTHERN MICHIGAN PHYSICAL MEDICINE PLC
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 2780 CHARLEVOIX AVE 19
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City | PETOSKEY
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State | MI
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Zip | 49770-8058
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Country | US
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Telephone | 231-347-9800
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Fax | 231-347-9850
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Provider Business Mailing Address
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Address Line | 2780 CHARLEVOIX AVE 19
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City | PETOSKEY
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State | MI
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Zip | 49770-8058
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Country | US
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Telephone | 231-347-9800
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Fax | 231-347-9850
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Authorized Official
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Title or Position | OFFICER
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Name | DR. GERALD KLOOSTER II
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Credential | D.O.
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Telephone | 231-347-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | GK012925
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License Number State | MI
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