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General NPI Number Information
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NPI Number | 1518145309
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Entity Type | Organization
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Legal Business Name | QUICK CARE FAMILY MEDICAL CENTER PC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 116 W MITCHELL ST
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City | PETOSKEY
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State | MI
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Zip | 49770-2324
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Country | US
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Telephone | 231-348-2828
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Fax | 231-348-9609
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Provider Business Mailing Address
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Address Line | 116 W MITCHELL ST
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City | PETOSKEY
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State | MI
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Zip | 49770-2324
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Country | US
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Telephone | 231-348-2828
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Fax | 231-348-9609
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GUSTAV J LO
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Credential | M.D.
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Telephone | 231-348-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | GL053321
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License Number State | MI
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