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General NPI Number Information
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NPI Number | 1396958500
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Entity Type | Organization
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Legal Business Name | NORTHERN MICHIGAN ALLERGY & ASTHMA CENTER, P.C.
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 07/13/2011
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Provider Practice Location Address
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Address Line | 405 N DIVISION RD SUITE 4
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City | PETOSKEY
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State | MI
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Zip | 49770-9045
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Country | US
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Telephone | 231-487-6575
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Fax | 231-439-9837
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Provider Business Mailing Address
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Address Line | 405 N DIVISION RD SUITE 4
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City | PETOSKEY
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State | MI
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Zip | 49770-9045
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Country | US
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Telephone | 231-487-6575
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Fax | 231-439-9837
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. JULIE MARIE LINEHAN
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Credential |
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Telephone | 231-487-6575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | AL052216
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License Number State | MI
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