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General NPI Number Information
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NPI Number | 1942370754
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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 | 11/09/2006
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Last Update Date | 04/15/2022
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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 | 231-487-4552
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Provider Business Mailing 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 | 231-487-7684
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Fax | 231-487-7721
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL PRUSAITIS
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Credential |
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Telephone | 559-450-3375
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State | MI
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