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General NPI Number Information
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NPI Number | 1760736094
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Entity Type | Organization
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Legal Business Name | MCLAREN NORTHERN MICHIGAN
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 416 CONNABLE AVE
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City | PETOSKEY
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State | MI
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Zip | 49770-2212
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Country | US
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Telephone | 231-487-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 775366
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City | CHICAGO
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State | IL
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Zip | 60677-5366
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Country | US
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Telephone | 231-487-4094
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Fax | 810-342-1590
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Authorized Official
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Title or Position | VP/CFO
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Name | STEVEN THOMPSON
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Credential |
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Telephone | 231-487-4094
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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 |
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License Number State |
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