MEDICARE: CENTRAL MICHIGAN OSTEOPOROSIS TREATMENT CENTER, PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	4301055180	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1101914331	OTHER	MI	BCBS OF MICHIGAN

General Provider Information

NPI Number	:	1013022086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL MICHIGAN OSTEOPOROSIS TREATMENT CENTER, PLC

Provider Business Mailing Address
First Line	:	1015 S US HIGHWAY 27
Second Line	:	SUITE B-37
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-2423
Country	:	US
Telephone Number	:	989-227-1800
Fax Number	:	989-227-1801

Provider Business Practice Location Address
First Line	:	1015 S US HIGHWAY 27
Second Line	:	SUITE B-37
City	:	SAINT JOHNS
State	:	MI
Zip	:	48879-2423
Country	:	US
Telephone Number	:	989-227-1800
Fax Number	:	989-227-1801

Authorized Official
Title or Position	:	OWNER
Name	:	LOUIS E WULFEKUHLER
Credential	:	M.D.
Telephone Number	:	989-227-1800

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/22/2020

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