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General NPI Number Information
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NPI Number | 1063713238
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Entity Type | Organization
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Legal Business Name | CEDAR STREET FAMILY MEDICINE PC
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 806 HOGSBACK RD SUITE C
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City | MASON
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State | MI
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Zip | 48854-9569
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Country | US
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Telephone | 517-244-1000
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Fax | 517-244-1030
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | MASON
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State | MI
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Zip | 48854
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Country | US
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Telephone | 517-244-1000
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Fax | 517-244-1030
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Authorized Official
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Title or Position | OWNER
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Name | CORRINE GARNER
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Credential | DO
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Telephone | 517-244-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101013448
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License Number State | MI
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