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General NPI Number Information
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NPI Number | 1528193612
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Entity Type | Organization
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Legal Business Name | SOLLLC
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 218 N PARK ST
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City | OWOSSO
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State | MI
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Zip | 48867-3040
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Country | US
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Telephone | 989-725-8114
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Fax | 989-725-8121
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Provider Business Mailing Address
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Address Line | 218 N PARK ST
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City | OWOSSO
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State | MI
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Zip | 48867-3040
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Country | US
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Telephone | 989-725-8114
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Fax | 989-725-8121
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Authorized Official
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Title or Position | OWNER
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Name | MR. HARRY J THURKOW
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Credential | BC-HIS
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Telephone | 989-725-8114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 3501001505
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License Number State | MI
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