NPI Code Detail JSON Logo

1386659043 NPI number — NORTHWEST MICHIGAN SURGICAL GROUP, P.C.

NPI Number: 1386659043
Health Care Provider/Practitioner: NORTHWEST MICHIGAN SURGICAL GROUP, P.C.

Information about “1386659043” NPI (NORTHWEST MICHIGAN SURGICAL GROUP, P.C.) exists in 1386659043 in HTML format HTML  |  1386659043 in plain Text format TXT  |  1386659043 in PDF (Portable Document Format) PDF  |  1386659043 in an XML format XML  formats.

NPI Number : 1386659043 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386659043",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NORTHWEST MICHIGAN SURGICAL GROUP, P.C.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "872 MUNSON AVE STE C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TRAVERSE CITY",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49686-3638",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "231-935-8346",
    "MailingAddressFaxNumber": "231-935-2850",
    "FirstLinePracticeLocationAddress": "872 MUNSON AVE STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TRAVERSE CITY",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49686-3638",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "231-935-8346",
    "PracticeLocationAddressFaxNumber": "231-935-2850",
    "EnumerationDate": "07/30/2006",
    "LastUpdateDate": "07/25/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "MCDONNELL",
    "AuthorizedOfficialFirstName": "JAMES",
    "AuthorizedOfficialMiddleName": "R.",
    "AuthorizedOfficialTitle": "PRESIDENT/OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "D.O.",
    "AuthorizedOfficialTelephoneNumber": "231-935-8346",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2086S0129X",
          "TaxonomyName": "Vascular Surgery Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "JM008369",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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