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General NPI Number Information
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NPI Number | 1932333135
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Entity Type | Organization
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Legal Business Name | NORTHERN MICHIGAN RHEUMATOLOGY PC
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 05/04/2009
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Provider Practice Location Address
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Address Line | 3280 WOODS WAY SUITE 1
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City | PETOSKEY
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State | MI
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Zip | 49770-8105
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Country | US
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Telephone | 231-995-4902
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Fax | 231-995-9074
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Provider Business Mailing Address
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Address Line | 3280 WOODS WAY SUITE 1
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City | PETOSKEY
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State | MI
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Zip | 49770-8105
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Country | US
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Telephone | 231-995-4902
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Fax | 231-995-9074
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. IRENE S KAZMERS
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Credential | MD
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Telephone | 231-995-4902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 4301041105
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License Number State | MI
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