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General NPI Number Information
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NPI Number | 1396609467
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Entity Type | Organization
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Legal Business Name | BIRCH SHORE PRIMARY CARE PLLC
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 3021 SCHOEDEL RD
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City | MANISTEE
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State | MI
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Zip | 49660-9753
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Country | US
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Telephone | 231-397-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 3021 SCHOEDEL RD
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City | MANISTEE
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State | MI
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Zip | 49660-9753
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Country | US
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Telephone | 231-397-9229
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | CHARLES VANDENBERG
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Credential | DO
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Telephone | 231-397-9229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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