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General NPI Number Information
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NPI Number | 1316041569
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Entity Type | Organization
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Legal Business Name | NORTHPORT MEDICAL CLINIC PLC
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Dates
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Enumeration Date | 09/09/2006
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 301 MILL STREET
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City | NORTHPORT
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State | MI
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Zip | 49670
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Country | US
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Telephone | 231-386-5450
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Fax | 231-386-7192
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Provider Business Mailing Address
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Address Line | PO BOX 907
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City | NORTHPORT
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State | MI
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Zip | 49670
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Country | US
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Telephone | 231-386-5450
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Fax | 231-386-7192
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARK J EICHENLAMB
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Credential | PAC
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Telephone | 231-386-5450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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