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General NPI Number Information
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NPI Number | 1518087386
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Entity Type | Organization
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Legal Business Name | NORTHERN MICHIGAN PAIN SPECIALISTS PC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 02/02/2009
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Provider Practice Location Address
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Address Line | 1420 PLAZA DR. STE 2B
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City | PETOSKEY
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State | MI
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Zip | 49770-9421
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Country | US
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Telephone | 231-487-4650
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Fax | 231-487-4613
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Provider Business Mailing Address
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Address Line | 1420 PLAZA DR. STE 2B
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City | PETOSKEY
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State | MI
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Zip | 49770-9421
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Country | US
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Telephone | 231-487-4650
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Fax | 231-487-4613
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. GARY LEE FUCHS
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Credential | M.D.
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Telephone | 231-487-4650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 5601003291
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License Number State | MI
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