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General NPI Number Information
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NPI Number | 1649383837
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Entity Type | Organization
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Legal Business Name | ROGERS CITY MEDICAL GROUP
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Dates
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Enumeration Date | 08/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 573 N BRADLEY HWY
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City | ROGERS CITY
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State | MI
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Zip | 49779-1508
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Country | US
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Telephone | 989-734-2171
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Fax | 989-734-2312
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Provider Business Mailing Address
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Address Line | 573 N BRADLEY HWY
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City | ROGERS CITY
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State | MI
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Zip | 49779-1508
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Country | US
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Telephone | 989-734-2171
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Fax | 989-734-2312
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. JENNIE MARIE KLINGSHIRN
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Credential | MSN
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Telephone | 989-734-2171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5010005938
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License Number State | MI
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