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General NPI Number Information
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NPI Number | 1821497579
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Entity Type | Organization
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Legal Business Name | ASPIRUS KEWEENAW
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 1000 CEDAR ST
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City | HOUGHTON
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State | MI
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Zip | 49931-1978
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Country | US
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Telephone | 906-482-5230
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Fax | 906-482-5343
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Provider Business Mailing Address
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Address Line | 29980 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1299
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Country | US
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Telephone | 906-482-5230
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Fax | 906-482-5343
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Authorized Official
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Title or Position | SVP & CHIEF FINANCIAL OFFICER
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Name | JERRY M YANG
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Credential |
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Telephone | 715-847-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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