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General NPI Number Information
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NPI Number | 1871677955
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Entity Type | Organization
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Legal Business Name | SENIOR MEDICAL CORP. P.C.
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 3944 S BRENLOR DR
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City | HESPERIA
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State | MI
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Zip | 49421-9585
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Country | US
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Telephone | 231-854-2999
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Fax | 231-854-2998
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Provider Business Mailing Address
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Address Line | 6087 E FILMORE RD
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City | WALKERVILLE
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State | MI
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Zip | 49459-9344
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Country | US
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Telephone | 231-854-7655
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Fax | 231-854-2998
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RAYMOND D TRACY
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Credential | D.O.
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Telephone | 231-854-2999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | RT007455
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License Number State | MI
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