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General NPI Number Information
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NPI Number | 1659387488
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Entity Type | Organization
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Legal Business Name | GRATIOT FAMILY PRACTICE PC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 160 E WARWICK DR
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City | ALMA
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State | MI
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Zip | 48801-1010
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Country | US
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Telephone | 989-463-3101
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Fax |
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Provider Business Mailing Address
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Address Line | 160 E WARWICK DR
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City | ALMA
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State | MI
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Zip | 48801-1010
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Country | US
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Telephone | 989-463-3101
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Fax | 989-463-2824
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Authorized Official
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Title or Position | MEDICAL PHYSCIAN
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Name | DR. VICKI E CHESSIN
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Credential | M.D.
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Telephone | 989-463-3101
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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 | 3822220235
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License Number State | MI
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