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General NPI Number Information
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NPI Number | 1689716557
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Entity Type | Organization
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Legal Business Name | CLINICAL PRACTICE MANAGERS AND CONSULTANTS OF NORTHWEST MICHIGAN PLLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 112 JOHN STREET
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City | LAKE CITY
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State | MI
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Zip | 49601
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Country | US
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Telephone | 231-839-4359
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Fax | 231-839-0223
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Provider Business Mailing Address
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Address Line | PO BOX 213
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City | CADILLAC
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State | MI
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Zip | 49601-0213
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Country | US
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Telephone | 231-775-6076
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Fax | 231-775-0027
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Authorized Official
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Title or Position | PRESIDENT
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Name | SOTERO URETA
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Credential | M.D.
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Telephone | 231-839-4359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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