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General NPI Number Information
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NPI Number | 1124137344
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Entity Type | Organization
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Legal Business Name | EAST SIDE FAMILY PHYSICIANS PC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 618 MULHOLLAND ST
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City | BAY CITY
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State | MI
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Zip | 48708-7645
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Country | US
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Telephone | 989-894-4700
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Fax | 989-895-6245
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Provider Business Mailing Address
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Address Line | 618 MULHOLLAND ST
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City | BAY CITY
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State | MI
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Zip | 48708-7645
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Country | US
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Telephone | 989-894-4700
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Fax | 989-895-6245
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KENDRA KAY RICHARD
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Credential | MA
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Telephone | 989-894-4700
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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 | NC014980
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License Number State | MI
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