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General NPI Number Information
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NPI Number | 1861766065
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Entity Type | Organization
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Legal Business Name | SUPERIOR FAMILY MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 550 OSBORN BLVD
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-1899
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Country | US
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Telephone | 906-632-0370
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Fax | 906-632-6373
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Provider Business Mailing Address
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Address Line | 550 OSBORN BLVD
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-1899
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Country | US
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Telephone | 906-632-0370
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Fax | 906-632-6373
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAAK MART PAHN
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Credential | MD
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Telephone | 906-632-0370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | MI
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